S T A T E   O F   N E W   Y O R K
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                                  6194

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                             March 16, 2015
                               ___________

Introduced  by  M.  of  A.  JOYNER, ABINANTI, AUBRY, BARRETT, BENEDETTO,
  BLAKE, BRINDISI, BUCHWALD, CLARK, COLTON, CRESPO, CUSICK,  CYMBROWITZ,
  DINOWITZ,  GALEF,  GJONAJ, GOTTFRIED, GUNTHER, HEVESI, JAFFEE, KEARNS,
  LAVINE, McDONALD, MOSLEY, MOYA, ORTIZ, OTIS,  PAULIN,  PEOPLES-STOKES,
  PERRY,  PICHARDO,  RODRIGUEZ, ROSENTHAL, SEPULVEDA, SIMANOWITZ, SIMON,
  SIMOTAS, SKOUFIS, THIELE, TITONE, WEPRIN, ZEBROWSKI -- Multi-Sponsored
  by -- M. of A.  ARROYO,  BRAUNSTEIN,  COOK,  FARRELL,  GLICK,  HOOPER,
  LENTOL,  LUPARDO,  MAYER, O'DONNELL, ROZIC, SCHIMEL, WEINSTEIN -- read
  once and referred to the Committee on Insurance

AN ACT to amend the insurance  law,  in  relation  to  the  purchase  of
  prescription drugs

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Paragraph 28 of subsection  (i)  of  section  3216  of  the
insurance  law, as amended by chapter 11 of the laws of 2012, is amended
to read as follows:
  (28) (A) DEFINITIONS. FOR THE PURPOSE OF THIS PARAGRAPH:
  (1) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
UNDER SUBPARAGRAPH (B) OF THIS PARAGRAPH SHALL PROVIDE THE  SAME  BENCH-
MARK  INDEX,  INCLUDING THE SAME AVERAGE WHOLESALE PRICE, MAXIMUM ALLOW-
ABLE COST AND NATIONAL PRESCRIPTION DRUG CODES TO REIMBURSE ALL  PHARMA-
CIES  PARTICIPATING  IN  THE  INSURANCE  NETWORK REGARDLESS OF WHETHER A
PHARMACY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.
  (2) "MAIL ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY  BUSINESS  IS
TO   RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX  OR  THROUGH  ELECTRONIC
SUBMISSIONS AND TO DISPENSE MEDICATION TO PATIENTS THROUGH  THE  USE  OF
THE  UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES AND
PROVIDES ANY  CONSULTATION  WITH  PATIENTS  ELECTRONICALLY  RATHER  THAN
FACE-TO-FACE.
  (B)  Any  policy  that  provides coverage for prescription drugs shall
permit each insured  to  fill  any  covered  prescription  that  may  be

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01495-01-5
              

A. 6194                             2

obtained at a network participating mail order or other non-retail phar-
macy, at the insured's option, at a network participating non-mail order
retail  pharmacy  provided that the network participating non-mail order
retail pharmacy agrees [in advance, through a contractual network agree-
ment,] to the same reimbursement amount[, as well as the same applicable
terms  and conditions,] that the insurer has established for the network
participating mail order or other non-retail pharmacy. In such  a  case,
the  policy  shall not impose a co-payment fee or other condition on any
insured who elects to purchase prescription drugs from a network partic-
ipating non-mail order retail pharmacy which  is  not  also  imposed  on
insureds  electing  to  purchase drugs from a network participating mail
order or other non-retail pharmacy.
  S 2. Paragraph 18 of subsection (l) of section 3221 of  the  insurance
law, as amended by chapter 11 of the laws of 2012, is amended to read as
follows:
  (18) (A) DEFINITIONS. FOR THE PURPOSE OF THIS PARAGRAPH:
  (1) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
UNDER  SUBPARAGRAPH  (B) OF THIS PARAGRAPH SHALL PROVIDE THE SAME BENCH-
MARK INDEX, INCLUDING THE SAME AVERAGE WHOLESALE PRICE,  MAXIMUM  ALLOW-
ABLE  COST AND NATIONAL PRESCRIPTION DRUG CODES TO REIMBURSE ALL PHARMA-
CIES PARTICIPATING IN THE INSURANCE  NETWORK  REGARDLESS  OF  WHETHER  A
PHARMACY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.
  (2)  "MAIL  ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY BUSINESS IS
TO  RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX  OR  THROUGH   ELECTRONIC
SUBMISSIONS  AND  TO  DISPENSE MEDICATION TO PATIENTS THROUGH THE USE OF
THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES  AND
PROVIDES  ANY  CONSULTATION  WITH  PATIENTS  ELECTRONICALLY  RATHER THAN
FACE-TO-FACE.
  (B) Any insurer delivering a group or  blanket  policy  or  issuing  a
group  or blanket policy for delivery in this state that provides cover-
age for prescription drugs shall permit each insured to fill any covered
prescription that may be obtained at a network participating mail  order
or  other  non-retail  pharmacy,  at  the insured's option, at a network
participating non-mail order retail pharmacy provided that  the  network
participating non-mail order retail pharmacy agrees [in advance, through
a  contractual network agreement,] to the same reimbursement amount[, as
well as the same applicable terms and conditions,] that the insurer  has
established for the network participating mail order or other non-retail
pharmacy.  In  such a case, the policy shall not impose a co-payment fee
or other condition on any insured who elects to purchase  drugs  from  a
network  participating  non-mail order retail pharmacy which is not also
imposed on insureds electing to purchase drugs from  a  network  partic-
ipating mail order or other non-retail pharmacy; provided, however, that
the  provisions  of  this  section  shall  not  supersede the terms of a
collective bargaining agreement or apply to a policy that is the  result
of  a  collective  bargaining agreement between an employer and a recog-
nized or certified employee organization.
  S 3. Subsection (kk) of section 4303 of the insurance law, as  amended
by  chapter  11  of  the laws of 2012 and as relettered by section 55 of
part D of chapter 56 of the laws of 2013, is amended to read as follows:
  (kk) (1) DEFINITIONS. FOR THE PURPOSE OF THIS SUBSECTION:
  (A) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
UNDER PARAGRAPH TWO OF THIS SUBSECTION SHALL PROVIDE THE SAME  BENCHMARK
INDEX,  INCLUDING  THE  SAME  AVERAGE WHOLESALE PRICE, MAXIMUM ALLOWABLE
COST AND NATIONAL PRESCRIPTION DRUG CODES TO  REIMBURSE  ALL  PHARMACIES

A. 6194                             3

PARTICIPATING IN THE HEALTH BENEFIT PLAN REGARDLESS OF WHETHER A PHARMA-
CY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.
  (B)  "MAIL  ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY BUSINESS IS
TO  RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX  OR  THROUGH   ELECTRONIC
SUBMISSIONS  AND  TO  DISPENSE MEDICATION TO PATIENTS THROUGH THE USE OF
THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES  AND
PROVIDES  ANY  CONSULTATION  WITH  PATIENTS  ELECTRONICALLY  RATHER THAN
FACE-TO-FACE.
  (2) Any contract issued by a medical expense indemnity corporation,  a
hospital  service  corporation  or  a  health  services corporation that
provides coverage for  prescription  drugs  shall  permit  each  covered
person  to  fill  any  covered  prescription  that  may be obtained at a
network participating mail order or other non-retail  pharmacy,  at  the
covered  person's  option,  at  a  network  participating non-mail order
retail pharmacy provided that the network participating  non-mail  order
retail pharmacy agrees [in advance, through a contractual network agree-
ment,] to the same reimbursement amount[, as well as the same applicable
terms  and  conditions,]  that  the  corporation has established for the
network participating mail order or other non-retail pharmacy.  In  such
a case, the contract shall not impose a copayment fee or other condition
on  any  covered  person  who  elects  to  purchase drugs from a network
participating non-mail order retail pharmacy which is not  also  imposed
on covered persons electing to purchase drugs from a network participat-
ing mail order or other non-retail pharmacy; provided, however, that the
provisions of this section shall not supersede the terms of a collective
bargaining  agreement  or  apply  to  a contract that is the result of a
collective bargaining agreement between an employer and a recognized  or
certified employee organization.
  S 4. This act shall take effect immediately.