S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  4899--A
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 5, 2019
                                ___________
 
 Introduced  by M. of A. RAMOS -- read once and referred to the Committee
   on Insurance -- recommitted to the Committee on Insurance  in  accord-
   ance  with  Assembly  Rule  3,  sec.  2  -- committee discharged, bill
   amended, ordered reprinted as amended and recommitted to said  commit-
   tee

 AN  ACT  to  amend the insurance law, in relation to coverage for single
   source drugs
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
 amended by adding a new paragraph 36 to read as follows:
   (36) EVERY INDIVIDUAL OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIV-
 ERY IN THIS STATE PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH  THE
 USE OF A DRUG FORMULARY SHALL INCLUDE A PROVISION WHICH, IN THE EVENT OF
 A  CHANGE  TO  SUCH  FORMULARY,  ALLOWS A COVERED PERSON WHO IS TAKING A
 SINGLE SOURCE DRUG COVERED UNDER SUCH POLICY THAT IS NO LONGER  INCLUDED
 IN  OR  PREFERRED  UNDER  SUCH FORMULARY AND HAS FILED A GRIEVANCE OR AN
 APPEAL OF THE DENIAL OF ACCESS TO THE DRUG WITH THE INSURER OR  A  STATE
 OR  FEDERAL  AGENCY  OR  DESIGNEE  OF SUCH AGENCY, TO CONTINUE RECEIVING
 COVERAGE FOR SUCH DRUG UNDER THE SAME  TERMS  AND  CONDITIONS  AS  WOULD
 APPLY  UNDER  THE  POLICY  WERE SUCH DRUG STILL INCLUDED IN OR PREFERRED
 UNDER THE FORMULARY, UNTIL A FINAL DECISION IS RENDERED ON THE APPEAL OR
 GRIEVANCE. FOR THE PURPOSE OF THIS PARAGRAPH, "SINGLE SOURCE DRUG" MEANS
 A BRANDNAME DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
   § 2. Subsection (k) of section 3221 of the insurance law is amended by
 adding a new paragraph 22 to read as follows:
   (22) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN
 THIS STATE PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH THE USE  OF
 A  DRUG  FORMULARY  SHALL  INCLUDE  A PROVISION WHICH, IN THE EVENT OF A
 CHANGE TO SUCH FORMULARY, ALLOWS A COVERED PERSON WHO IS TAKING A SINGLE
 SOURCE DRUG COVERED UNDER SUCH POLICY THAT IS NO LONGER INCLUDED  IN  OR
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD07563-02-0

 A. 4899--A                          2
 
 PREFERRED UNDER SUCH FORMULARY AND HAS FILED A GRIEVANCE OR AN APPEAL OF
 THE  DENIAL OF ACCESS TO THE DRUG WITH THE INSURER OR A STATE OR FEDERAL
 AGENCY OR DESIGNEE OF SUCH AGENCY, TO CONTINUE  RECEIVING  COVERAGE  FOR
 SUCH  DRUG  UNDER THE SAME TERMS AND CONDITIONS AS WOULD APPLY UNDER THE
 POLICY WERE SUCH DRUG STILL INCLUDED IN OR PREFERRED  UNDER  THE  FORMU-
 LARY, UNTIL A FINAL DECISION IS RENDERED ON THE APPEAL OR GRIEVANCE. FOR
 THE  PURPOSE  OF  THIS PARAGRAPH, "SINGLE SOURCE DRUG" MEANS A BRANDNAME
 DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
   § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (ss) to read as follows:
   (SS)  EVERY  CONTRACT  DELIVERED  OR ISSUED FOR DELIVERY IN THIS STATE
 PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH  THE  USE  OF  A  DRUG
 FORMULARY  SHALL  INCLUDE A PROVISION WHICH, IN THE EVENT OF A CHANGE TO
 SUCH FORMULARY, ALLOWS A COVERED PERSON WHO IS TAKING  A  SINGLE  SOURCE
 DRUG  COVERED  UNDER  SUCH  CONTRACT  THAT  IS  NO LONGER INCLUDED IN OR
 PREFERRED UNDER SUCH FORMULARY AND HAS FILED A GRIEVANCE OR AN APPEAL OF
 THE DENIAL OF ACCESS TO THE DRUG WITH THE INSURER CORPORATION OR  ORGAN-
 IZATION  CERTIFIED  PURSUANT  TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
 LAW OR A STATE OR FEDERAL AGENCY OR DESIGNEE OF SUCH AGENCY, TO CONTINUE
 RECEIVING COVERAGE FOR SUCH DRUG UNDER THE SAME TERMS AND CONDITIONS  AS
 WOULD  APPLY  UNDER  THE  CONTRACT  WERE  SUCH DRUG STILL INCLUDED IN OR
 PREFERRED UNDER THE FORMULARY, UNTIL A FINAL DECISION IS RENDERED ON THE
 APPEAL OR GRIEVANCE. FOR THE PURPOSE OF THIS SUBSECTION, "SINGLE  SOURCE
 DRUG" MEANS A BRANDNAME DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
   §  4.  This  act  shall take effect on the first of the calendar month
 next succeeding the sixtieth day after  it  shall  have  become  a  law;
 provided,  however,  that  this  act  shall  apply  only to policies and
 contracts issued, renewed or amended on or after such effective date.