NY State Senate Bill 2017-S8934

Senate Bill S8934

2017-2018 Legislative Session

Provides for pharmacy benefit management and the procurement of prescription drugs at a negotiated rate for dispensation; repealer

download bill text pdf

Archive: Last Bill Status - In Senate Committee Rules Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

Please enter your contact information

First Name

Last Name

Email Address

A valid email address is required.

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 06, 2018	referred to rules

2017-S8934 (ACTIVE) - Details

See Assembly Version of this Bill:: A10985
Current Committee:: Senate Rules
Law Section:: Public Health Law
Laws Affected:: Rpld & add §280-a, Pub Health L
Versions Introduced in 2019-2020 Legislative Session:: S2087, A2836

2017-S8934 (ACTIVE) - Summary

Provides for pharmacy benefit management and the procurement of prescription drugs to be dispensed to patients, or the administration or management of prescription drug benefits; sets forth definitions; provides for funds received by a pharmacy in trust for the health plan or provider and provides for accountability of such funds; further provides for an appeals process to investigate and resolve disputes regarding multi-source generic drug pricing.

2017-S8934 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S8934

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the public health law, in relation to pharmacy benefit
managers; and to repeal certain provisions of such law relating thereto

 
PURPOSE OR GENERAL IDEA OF BILL:

This bill requires licensure for pharmacy benefit managers (PBMs) and
specifies their duties and obligations as service providers.

 
SUMMARY OF SPECIFIC PROVISIONS:

The bill amends Public Health Law § 280-a to provide that PBMs have a
fiduciary relationship with health plan or health care provider clients,
require that funds they receive belong to the client except for fees for
services specifically provided for by contract, require full disclosure
to clients, and bars the substitution of prescribed drugs (subdivisions
1-3).

Subdivision 4 is current subdivision 2 renumbered, and subdivision 5
renumbers a provision that was added as part of the 2018 state budget.

Subdivisions 6 through 9 require PBMs to be licensed, renewable every
five years, with a fee of $10,000. The bill establishes grounds and
procedure for suspension, revocation or refusal to grant or renew a
license. Existing PBMs are provided an additional 180 days to comply
with the initial licensure. Grounds for disciplinary action include
fraudulent applications or practices, incompetence, financial irrespon-
sibility, and felony conviction, with appropriate notice and opportunity
for a PBM to be heard and defend against the charges.

 
JUSTIFICATION:

PBMs are companies that manage prescription drug benefit programs for
health plans. PBMs promote themselves as saving money for health plans
and their members, but in reality, their negotiations and the discounts
or rebates they get from drug companies are very secretive.  PBMs
commonly pocket payments from drug manufacturers that ought to be used
to lower drug prices, and they accept payments in exchange for giving
preference to more expensive drugs. Like a real estate broker or a
lawyer, they ought to be required to act in the best interests of the
client (i.e., fiduciary relationship). This bill would require that PBMs
be licensed by the Health Department and conform to standards estab-
lished by the Department.

 
PRIOR LEGISLATIVE HISTORY:

New bill

 
FISCAL IMPLICATIONS:

None

 
EFFECTIVE DATE:
90 days after it shall become law.

2017-S8934 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8934
 
                             I N  S E N A T E
 
                               June 6, 2018
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Rules
 
 AN ACT to amend the public health law, in relation to  pharmacy  benefit
   managers; and to repeal certain provisions of such law relating there-
   to
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Section 280-a of the public health law is  REPEALED  and  a
 new section 280-a is added to read as follows:
   §  280-A.  PHARMACY BENEFIT MANAGERS. 1. DEFINITIONS.  AS USED IN THIS
 SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
   (A) "HEALTH PLAN OR PROVIDER" MEANS AN ENTITY  FOR  WHICH  A  PHARMACY
 BENEFIT  MANAGER PROVIDES PHARMACY BENEFIT MANAGEMENT INCLUDING, BUT NOT
 LIMITED TO: (I) A HEALTH BENEFIT PLAN OR  OTHER  ENTITY  THAT  APPROVES,
 PROVIDES, ARRANGES FOR, OR PAYS FOR HEALTH CARE ITEMS OR SERVICES, UNDER
 WHICH  PRESCRIPTION  DRUGS FOR BENEFICIARIES OF THE ENTITY ARE PURCHASED
 OR WHICH PROVIDES OR ARRANGES REIMBURSEMENT IN WHOLE OR IN PART FOR  THE
 PURCHASE  OF  PRESCRIPTION  DRUGS;  OR  (II)  A  HEALTH CARE PROVIDER OR
 PROFESSIONAL,  INCLUDING  A  STATE  OR  LOCAL  GOVERNMENT  ENTITY,  THAT
 ACQUIRES  PRESCRIPTION DRUGS TO USE OR DISPENSE IN PROVIDING HEALTH CARE
 TO PATIENTS.
   (B) "PHARMACY BENEFIT MANAGEMENT" MEANS  THE  SERVICE  PROVIDED  TO  A
 HEALTH PLAN OR PROVIDER, DIRECTLY OR THROUGH ANOTHER ENTITY, AND REGARD-
 LESS  OF  WHETHER  THE  PHARMACY  BENEFIT MANAGER AND THE HEALTH PLAN OR
 PROVIDER ARE RELATED, OR  ASSOCIATED  BY  OWNERSHIP,  COMMON  OWNERSHIP,
 ORGANIZATION  OR  OTHERWISE;  INCLUDING  THE PROCUREMENT OF PRESCRIPTION
 DRUGS TO BE DISPENSED TO PATIENTS, OR THE ADMINISTRATION  OR  MANAGEMENT
 OF  PRESCRIPTION DRUG BENEFITS, INCLUDING BUT NOT LIMITED TO, ANY OF THE
 FOLLOWING:
   (I) MAIL SERVICE PHARMACY;
   (II) CLAIMS PROCESSING,  RETAIL  NETWORK  MANAGEMENT,  OR  PAYMENT  OF
 CLAIMS TO PHARMACIES FOR DISPENSING PRESCRIPTION DRUGS;
   (III)  CLINICAL  OR OTHER FORMULARY OR PREFERRED DRUG LIST DEVELOPMENT
 OR MANAGEMENT;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD16054-01-8

 S. 8934                             2
 
   (IV) NEGOTIATION OR  ADMINISTRATION  OF  REBATES,  DISCOUNTS,  PAYMENT
 DIFFERENTIALS,  OR  OTHER  INCENTIVES,  FOR  THE INCLUSION OF PARTICULAR
 PRESCRIPTION DRUGS IN A PARTICULAR CATEGORY OR TO PROMOTE  THE  PURCHASE
 OF PARTICULAR PRESCRIPTION DRUGS;
   (V)  PATIENT  COMPLIANCE, THERAPEUTIC INTERVENTION, OR GENERIC SUBSTI-
 TUTION PROGRAMS; AND
   (VI) DISEASE MANAGEMENT.
   (C) "PHARMACY BENEFIT MANAGER" MEANS ANY ENTITY THAT PERFORMS PHARMACY
 BENEFIT MANAGEMENT FOR A HEALTH PLAN OR PROVIDER.
   (D) "MAXIMUM ALLOWABLE  COST  PRICE"  MEANS  A  MAXIMUM  REIMBURSEMENT
 AMOUNT  SET  BY  THE PHARMACY BENEFIT MANAGER FOR THERAPEUTICALLY EQUIV-
 ALENT MULTIPLE SOURCE GENERIC DRUGS.
   (E) "CONTROLLING PERSON" MEANS ANY PERSON OR OTHER ENTITY WHO OR WHICH
 DIRECTLY OR INDIRECTLY HAS THE POWER TO DIRECT OR CAUSE TO  BE  DIRECTED
 THE MANAGEMENT, CONTROL OR ACTIVITIES OF A PHARMACY BENEFIT MANAGER.
   (F)  "COVERED  INDIVIDUAL"  MEANS  A  MEMBER,  PARTICIPANT,  ENROLLEE,
 CONTRACT HOLDER OR POLICY HOLDER OR BENEFICIARY  OF  A  HEALTH  PLAN  OR
 PROVIDER.
   (G)  "LICENSE" MEANS A LICENSE TO BE A PHARMACY BENEFIT MANAGER, UNDER
 SUBDIVISION SEVEN OF THIS SECTION.
   2. DUTY, ACCOUNTABILITY AND TRANSPARENCY.   (A) THE  PHARMACY  BENEFIT
 MANAGER  SHALL  HAVE A FIDUCIARY RELATIONSHIP WITH AND OBLIGATION TO THE
 HEALTH PLAN OR PROVIDER, AND SHALL PERFORM PHARMACY  BENEFIT  MANAGEMENT
 WITH CARE, SKILL, PRUDENCE, DILIGENCE, AND PROFESSIONALISM.
   (B)  ALL FUNDS RECEIVED BY THE PHARMACY BENEFIT MANAGER IN RELATION TO
 PROVIDING PHARMACY BENEFIT MANAGEMENT SHALL BE RECEIVED BY THE  PHARMACY
 BENEFIT  MANAGER  IN  TRUST FOR THE HEALTH PLAN OR PROVIDER AND SHALL BE
 USED OR DISTRIBUTED ONLY PURSUANT  TO  THE  PHARMACY  BENEFIT  MANAGER'S
 CONTRACT,  OR  OTHER TERMS IN THE ABSENCE OF A CONTRACT, WITH THE HEALTH
 PLAN OR PROVIDER OR APPLICABLE  LAW;  EXCEPT  FOR  ANY  FEE  OR  PAYMENT
 EXPRESSLY PROVIDED FOR IN THE CONTRACT, OR OTHER TERMS IN THE ABSENCE OF
 A  CONTRACT, BETWEEN THE PHARMACY BENEFIT MANAGER AND THE HEALTH PLAN OR
 PROVIDER TO COMPENSATE THE PHARMACY BENEFIT MANAGER FOR ITS SERVICES.
   (C) THE PHARMACY BENEFIT MANAGER SHALL  PERIODICALLY  ACCOUNT  TO  THE
 HEALTH  PLAN  OR PROVIDER FOR ALL FUNDS RECEIVED BY THE PHARMACY BENEFIT
 MANAGER. THE HEALTH PLAN OR PROVIDER SHALL HAVE ACCESS TO ALL  FINANCIAL
 AND  UTILIZATION INFORMATION OF THE PHARMACY BENEFIT MANAGER IN RELATION
 TO PHARMACY BENEFIT MANAGEMENT PROVIDED TO THE HEALTH PLAN OR PROVIDER.
   (D) THE PHARMACY BENEFIT MANAGER SHALL  DISCLOSE  IN  WRITING  TO  THE
 HEALTH  PLAN  OR  PROVIDER  THE  TERMS AND CONDITIONS OF ANY CONTRACT OR
 ARRANGEMENT BETWEEN THE PHARMACY BENEFIT MANAGER AND ANY PARTY  RELATING
 TO PHARMACY BENEFIT MANAGEMENT PROVIDED TO THE HEALTH PLAN OR PROVIDER.
   (E)  THE  PHARMACY  BENEFIT  MANAGER  SHALL DISCLOSE IN WRITING TO THE
 HEALTH PLAN OR PROVIDER ANY  ACTIVITY,  POLICY,  PRACTICE,  CONTRACT  OR
 ARRANGEMENT  OF THE PHARMACY BENEFIT MANAGER THAT DIRECTLY OR INDIRECTLY
 PRESENTS ANY CONFLICT OF INTEREST WITH THE  PHARMACY  BENEFIT  MANAGER'S
 RELATIONSHIP WITH OR OBLIGATION TO THE HEALTH PLAN OR PROVIDER.
   (F)  ANY  INFORMATION  REQUIRED  TO BE DISCLOSED BY A PHARMACY BENEFIT
 MANAGER TO A HEALTH PLAN OR PROVIDER UNDER THIS SECTION THAT IS  REASON-
 ABLY  DESIGNATED BY THE PHARMACY BENEFIT MANAGER AS PROPRIETARY OR TRADE
 SECRET INFORMATION SHALL BE KEPT CONFIDENTIAL  BY  THE  HEALTH  PLAN  OR
 PROVIDER,  EXCEPT  AS REQUIRED OR PERMITTED BY LAW, INCLUDING DISCLOSURE
 NECESSARY TO PROSECUTE OR DEFEND ANY LEGITIMATE LEGAL CLAIM OR CAUSE  OF
 ACTION.
   (G) THE COMMISSIONER SHALL ESTABLISH, BY REGULATION, MINIMUM STANDARDS
 FOR  PHARMACY BENEFIT MANAGEMENT SERVICES WHICH SHALL ADDRESS THE ELIMI-

 S. 8934                             3
 
 NATION OF CONFLICTS OF INTEREST BETWEEN PHARMACY  BENEFIT  MANAGERS  AND
 HEALTH  INSURERS,  PLANS AND PROVIDERS; AND THE ELIMINATION OF DECEPTIVE
 PRACTICES, ANTI-COMPETITIVE PRACTICES, AND UNFAIR CLAIMS PRACTICES.
   3.  PRESCRIPTIONS.    A PHARMACY BENEFIT MANAGER MAY NOT SUBSTITUTE OR
 CAUSE THE SUBSTITUTING OF ONE PRESCRIPTION DRUG FOR ANOTHER IN  DISPENS-
 ING  A  PRESCRIPTION,  OR  ALTER OR CAUSE THE ALTERING OF THE TERMS OF A
 PRESCRIPTION, EXCEPT WITH THE APPROVAL OF THE PRESCRIBER OR AS EXPLICIT-
 LY REQUIRED OR PERMITTED BY LAW.
   4. APPEALS.   A  PHARMACY  BENEFIT  MANAGER  SHALL,  WITH  RESPECT  TO
 CONTRACTS BETWEEN A PHARMACY BENEFIT MANAGER AND A PHARMACY OR, ALTERNA-
 TIVELY,  A  PHARMACY BENEFIT MANAGER AND A PHARMACY'S CONTRACTING AGENT,
 SUCH AS A  PHARMACY  SERVICES  ADMINISTRATIVE  ORGANIZATION,  INCLUDE  A
 REASONABLE PROCESS TO APPEAL, INVESTIGATE AND RESOLVE DISPUTES REGARDING
 MULTI-SOURCE GENERIC DRUG PRICING. THE APPEALS PROCESS SHALL INCLUDE THE
 FOLLOWING PROVISIONS:
   (A)  THE  RIGHT  TO  APPEAL  BY  THE  PHARMACY  AND/OR  THE PHARMACY'S
 CONTRACTING AGENT SHALL BE LIMITED TO THIRTY DAYS FOLLOWING THE  INITIAL
 CLAIM SUBMITTED FOR PAYMENT;
   (B)  A  TELEPHONE  NUMBER THROUGH WHICH A NETWORK PHARMACY MAY CONTACT
 THE PHARMACY BENEFIT MANAGER FOR THE PURPOSE OF FILING AN APPEAL AND  AN
 ELECTRONIC  MAIL  ADDRESS OF THE INDIVIDUAL WHO IS RESPONSIBLE FOR PROC-
 ESSING APPEALS;
   (C) THE PHARMACY BENEFIT MANAGER SHALL SEND AN ELECTRONIC MAIL MESSAGE
 ACKNOWLEDGING RECEIPT OF THE APPEAL. THE PHARMACY BENEFIT MANAGER  SHALL
 RESPOND  IN  AN ELECTRONIC MESSAGE TO THE PHARMACY AND/OR THE PHARMACY'S
 CONTRACTING AGENT FILING THE APPEAL WITHIN SEVEN BUSINESS DAYS  INDICAT-
 ING  ITS  DETERMINATION.  IF  THE  APPEAL IS DETERMINED TO BE VALID, THE
 MAXIMUM ALLOWABLE COST FOR THE DRUG SHALL BE ADJUSTED FOR THE  APPEALING
 PHARMACY EFFECTIVE AS OF THE DATE OF THE ORIGINAL CLAIM FOR PAYMENT. THE
 PHARMACY BENEFIT MANAGER SHALL REQUIRE THE APPEALING PHARMACY TO REVERSE
 AND  REBILL  THE  CLAIM  IN  QUESTION  IN  ORDER TO OBTAIN THE CORRECTED
 REIMBURSEMENT;
   (D) IF AN UPDATE TO THE MAXIMUM ALLOWABLE COST IS WARRANTED, THE PHAR-
 MACY BENEFIT MANAGER OR COVERED ENTITY SHALL ADJUST THE  MAXIMUM  ALLOW-
 ABLE COST OF THE DRUG EFFECTIVE FOR ALL SIMILARLY SITUATED PHARMACIES IN
 ITS  NETWORK  IN  THE  STATE ON THE DATE THE APPEAL WAS DETERMINED TO BE
 VALID; AND
   (E) IF AN APPEAL IS DENIED, THE PHARMACY BENEFIT MANAGER SHALL IDENTI-
 FY THE NATIONAL DRUG CODE  OF  A  THERAPEUTICALLY  EQUIVALENT  DRUG,  AS
 DETERMINED  BY  THE FEDERAL FOOD AND DRUG ADMINISTRATION, THAT IS AVAIL-
 ABLE FOR PURCHASE BY PHARMACIES IN THIS STATE  FROM  WHOLESALERS  REGIS-
 TERED  PURSUANT TO SUBDIVISION FOUR OF SECTION SIXTY-EIGHT HUNDRED EIGHT
 OF THE EDUCATION LAW AT A PRICE WHICH IS EQUAL TO OR LESS THAN THE MAXI-
 MUM ALLOWABLE COST FOR THAT DRUG AS DETERMINED BY THE  PHARMACY  BENEFIT
 MANAGER.
   5.  CONTRACT  PROVISIONS.    NO  PHARMACY  BENEFIT MANAGER SHALL, WITH
 RESPECT TO CONTRACTS BETWEEN SUCH PHARMACY BENEFIT MANAGER AND A PHARMA-
 CY OR, ALTERNATIVELY, SUCH PHARMACY BENEFIT  MANAGER  AND  A  PHARMACY'S
 CONTRACTING  AGENT, SUCH AS A PHARMACY SERVICES ADMINISTRATIVE ORGANIZA-
 TION:
   (A) PROHIBIT OR PENALIZE A PHARMACIST OR PHARMACY FROM  DISCLOSING  TO
 AN  INDIVIDUAL  PURCHASING A PRESCRIPTION MEDICATION INFORMATION REGARD-
 ING:
   (1) THE COST OF THE PRESCRIPTION MEDICATION TO THE INDIVIDUAL, OR

 S. 8934                             4
 
   (2) THE AVAILABILITY OF  ANY  THERAPEUTICALLY  EQUIVALENT  ALTERNATIVE
 MEDICATIONS  OR ALTERNATIVE METHODS OF PURCHASING THE PRESCRIPTION MEDI-
 CATION, INCLUDING BUT NOT LIMITED TO, PAYING A CASH PRICE; OR
   (B)  CHARGE OR COLLECT FROM AN INDIVIDUAL A COPAYMENT THAT EXCEEDS THE
 TOTAL SUBMITTED CHARGES BY THE PHARMACY FOR WHICH THE PHARMACY IS  PAID.
 IF AN INDIVIDUAL PAYS A COPAYMENT, THE PHARMACY SHALL RETAIN THE ADJUDI-
 CATED  COSTS AND THE PHARMACY BENEFIT MANAGER SHALL NOT REDACT OR RECOUP
 THE ADJUDICATED COST.
   6. ACTING WITHOUT A LICENSE. (A) NO PERSON OR  ENTITY  MAY  ACT  AS  A
 PHARMACY  BENEFIT MANAGER ON OR AFTER JANUARY FIRST, TWO THOUSAND TWENTY
 WITHOUT HAVING A CURRENTLY VALID LICENSE UNDER THIS SECTION. HOWEVER,  A
 PHARMACY  BENEFIT  MANAGER  PROVIDING PHARMACY BENEFIT MANAGEMENT ON AND
 BEFORE THAT DATE MAY CONTINUE TO DO SO  WITHOUT  A  LICENSE  UNDER  THIS
 SECTION FOR A PERIOD OF ONE HUNDRED EIGHTY DAYS.
   (B)  NO  HEALTH PLAN OR PROVIDER MAY PAY ANY FEE OR OTHER COMPENSATION
 FOR PHARMACY BENEFIT MANAGEMENT  TO  ANY  PERSON  OR  ENTITY  ACTING  IN
 VIOLATION OF THIS SUBDIVISION.
   (C)  ANY  PERSON OR ENTITY THAT VIOLATES THIS SECTION SHALL BE SUBJECT
 TO PENALTIES UNDER SECTIONS TWELVE AND TWELVE-B OF THIS CHAPTER.
   7. LICENSING OF PHARMACY BENEFIT MANAGERS. (A)  THE  COMMISSIONER  MAY
 ISSUE  A PHARMACY BENEFIT MANAGER LICENSE TO ANY PERSON OR ENTITY WHO OR
 THAT APPLIES FOR A LICENSE AND HAS COMPLIED  WITH  THE  REQUIREMENTS  OF
 THIS  SECTION.  THE  COMMISSIONER  MAY ESTABLISH, BY REGULATION, MINIMUM
 STANDARDS FOR THE ISSUANCE OF A LICENSE TO A PHARMACY  BENEFIT  MANAGER.
 THE  TERM  OF  EACH  LICENSE  SHALL BE A PERIOD OF FIVE YEARS AND MAY BE
 RENEWED BY THE COMMISSIONER.
   (B)(1) BEFORE A PHARMACY BENEFIT MANAGER'S LICENSE SHALL BE ISSUED  OR
 RENEWED,  THE  PROSPECTIVE  LICENSEE SHALL FILE A WRITTEN APPLICATION IN
 SUCH FORM OR FORMS AND SUPPLEMENTS AS THE COMMISSIONER MAY REQUIRE,  AND
 PAY A FEE OF TEN THOUSAND DOLLARS.
   (2)  EVERY  LICENSE  ISSUED PURSUANT TO THIS SECTION MAY BE RENEWED BY
 FILING THE APPLICATION AND PAYING THE FEES AT LEAST SIXTY DAYS PRIOR  TO
 THE  EXPIRATION OF THE LICENSE, UPON WHICH THE LICENSE SHALL CONTINUE IN
 FULL FORCE AND EFFECT UNTIL EITHER (A) THE ISSUANCE BY THE  COMMISSIONER
 OF  THE RENEWED LICENSE OR (B) FIVE BUSINESS DAYS AFTER THE COMMISSIONER
 SHALL HAVE GIVEN NOTICE TO  THE  APPLICANT  THAT  THE  COMMISSIONER  HAS
 REJECTED THE RENEWAL.
   (C)  THE  COMMISSIONER MAY REFUSE TO ISSUE OR RENEW A PHARMACY BENEFIT
 MANAGER'S LICENSE IF, IN THE COMMISSIONER'S JUDGMENT, THE  APPLICANT  OR
 ANY  MEMBER,  PRINCIPAL,  OFFICER  OR  DIRECTOR OF THE APPLICANT, IS NOT
 TRUSTWORTHY OR COMPETENT TO ACT AS A PHARMACY BENEFIT MANAGER, OR IF THE
 COMMISSIONER IS AWARE OF CAUSE FOR  REVOCATION  OR  SUSPENSION  OF  SUCH
 LICENSE.  THE  COMMISSIONER SHALL NOTIFY THE LICENSEE OF A DETERMINATION
 TO REJECT THE APPLICATION FOR THE LICENSE OR RENEWAL AND AN  EXPLANATION
 OF  THE  CAUSE FOR REJECTION, AND SHALL PROVIDE A REASONABLE OPPORTUNITY
 FOR THE LICENSEE TO BE HEARD UNDER SUBDIVISION EIGHT OF THIS SECTION.
   (D) LICENSEES SHALL BE SUBJECT TO  EXAMINATION  AT  ANY  TIME  BY  THE
 COMMISSIONER.
   8.  REVOCATION  OR SUSPENSION OF A LICENSE. (A) THE COMMISSIONER, UPON
 HIS OR HER OWN  INVESTIGATION  OR  COMPLAINT  FROM  ANOTHER  PARTY,  MAY
 REVOKE,  SUSPEND OR REFUSE TO RENEW A LICENSE IF, AFTER NOTICE AND HEAR-
 ING, THE COMMISSIONER DETERMINES THAT THE LICENSEE, HAS, IN RELATION  TO
 PHARMACY  BENEFIT  MANAGEMENT  OR  THE OPERATION OF THE PHARMACY BENEFIT
 MANAGER:
   (1) VIOLATED ANY LAW, REGULATION, SUBPOENA OR ORDER OF THE COMMISSION-
 ER, OR OF ANOTHER STATE THAT WOULD CONSTITUTE A VIOLATION IN NEW YORK;

 S. 8934                             5
 
   (2) PROVIDED MATERIALLY INCORRECT, MATERIALLY  MISLEADING,  MATERIALLY
 INCOMPLETE OR MATERIALLY UNTRUE INFORMATION IN A LICENSE APPLICATION;
   (3)  OBTAINED  OR  ATTEMPTED  TO OBTAIN A LICENSE THROUGH MISREPRESEN-
 TATION OR FRAUD;
   (4) USED FRAUDULENT, COERCIVE OR DISHONEST PRACTICES;
   (5) DEMONSTRATED INCOMPETENCE;
   (6) DEMONSTRATED UNTRUSTWORTHINESS;
   (7) DEMONSTRATED FINANCIAL IRRESPONSIBILITY  IN  THE  CONDUCT  OF  THE
 BUSINESS;
   (8)  IMPROPERLY  WITHHELD,  MISAPPROPRIATED OR CONVERTED ANY MONIES OR
 PROPERTIES;
   (9) INTENTIONALLY MISREPRESENTED THE TERMS OF AN  ACTUAL  OR  PROPOSED
 CONTRACT WITH ANY PARTY;
   (10) BEEN CONVICTED OF A FELONY;
   (11)  HAD  A  PHARMACY  BENEFIT  MANAGER  LICENSE,  OR ITS EQUIVALENT,
 DENIED, SUSPENDED OR REVOKED IN ANY OTHER STATE, PROVINCE,  DISTRICT  OR
 TERRITORY; OR
   (12) CEASED TO MEET THE REQUIREMENTS FOR LICENSURE UNDER THIS SECTION.
   (B)  BEFORE  REVOKING,  SUSPENDING OR REFUSING TO RENEW A LICENSE, THE
 COMMISSIONER SHALL GIVE NOTICE TO THE LICENSEE AND SHALL HOLD, OR  CAUSE
 TO  BE  HELD, A HEARING AS PROVIDED UNDER SECTION TWELVE-A OF THIS CHAP-
 TER. THE COMMISSIONER SHALL ALSO GIVE NOTICE TO HEALTH PLANS AND PROVID-
 ERS UNDER CONTRACT WITH THE PHARMACY  BENEFIT  MANAGER,  TO  THE  EXTENT
 KNOWN TO THE COMMISSIONER.
   (C)  IF A LICENSE IS REVOKED OR SUSPENDED, THE COMMISSIONER SHALL GIVE
 NOTICE TO THE LICENSEE AND HEALTH PLANS  AND  PROVIDERS  UNDER  CONTRACT
 WITH THE PHARMACY BENEFIT MANAGER TO THE EXTENT KNOWN TO THE COMMISSION-
 ER.
   9.  CHANGE  OF  ADDRESS.  A  REGISTRANT OR LICENSEE UNDER THIS SECTION
 SHALL INFORM THE COMMISSIONER BY A MEANS ACCEPTABLE TO THE  COMMISSIONER
 OF A CHANGE OF ADDRESS WITHIN THIRTY DAYS OF THE CHANGE.
   10.  VIOLATIONS.    ANY  PROVISION  OF  A  CONTRACT  THAT VIOLATES THE
 PROVISIONS OF THIS SECTION SHALL BE DEEMED TO BE VOID AND UNENFORCEABLE.
   § 2. Severability.  If any provision of this act, or  any  application
 of  any  provision  of  this act, is held to be invalid, or ruled by any
 federal agency to violate or be inconsistent with any applicable federal
 law or regulation, that shall not affect the validity  or  effectiveness
 of  any  other provision of this act, or of any other application of any
 provision of this act.
   § 3. This act shall take effect on the ninetieth day  after  it  shall
 become  a  law  and  shall  apply to any contract for providing pharmacy
 benefit management made or renewed on  or  after  that  date.  Effective
 immediately,  the commissioner of health shall make regulations and take
 other actions reasonably necessary to implement this act on that date.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.