S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8533
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              August 14, 2019
                                ___________
 
 Introduced by M. of A. JOYNER -- read once and referred to the Committee
   on Health
 
 AN  ACT  to  amend the public health law, in relation to drug assistance
   demonstration and emergency prescriptions; and to amend the  insurance
   law, in relation to capping cost sharing for insulin

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The public health law is amended by adding two new sections
 279-a and 279-b to read as follows:
   § 279-A. DRUG ASSISTANCE DEMONSTRATION PROGRAM. THE COMMISSIONER SHALL
 DEVELOP A DEMONSTRATION PROGRAM TO ENSURE ACCESS TO  INSULIN  AND  OTHER
 LIFE  SUSTAINING, MAINTENANCE PRESCRIPTION MEDICATIONS IDENTIFIED BY THE
 COMMISSIONER FOR RESIDENTS OF THE STATE WHO ARE UNINSURED, ARE  INELIGI-
 BLE FOR MEDICAID OR OTHER PUBLICLY FUNDED HEALTH COVERAGE, OR ARE OTHER-
 WISE  DETERMINED TO BE ELIGIBLE BY THE COMMISSIONER AND DEPEND UPON SUCH
 MEDICATION FOR THEIR SURVIVAL. IN DEVELOPING SUCH  PROGRAM  THE  COMMIS-
 SIONER SHALL:
   1.  CONSIDER MODELING THE DRUG ASSISTANCE DEMONSTRATION PROGRAM ON THE
 STATE'S HIV/AIDS DRUG ASSISTANCE PROGRAM PROVIDING  ACCESS  TO  ELIGIBLE
 INDIVIDUALS  AT  CERTAIN  INCOME  THRESHOLDS  ABOVE  THE FEDERAL POVERTY
 LEVEL;
   2. ENGAGE  WITH  PHARMACEUTICAL  MANUFACTURERS  TO  EXPLORE  A  PUBLIC
 PRIVATE PARTNERSHIP DESIGNED TO BRING AFFORDABLE MEDICATIONS THROUGH THE
 DEMONSTRATION PROGRAM TO ELIGIBLE INDIVIDUALS; AND
   3.  REPORT TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE, THE
 SPEAKER OF THE ASSEMBLY, AND THE  CHAIRS  OF  THE  SENATE  AND  ASSEMBLY
 HEALTH  COMMITTEES  ON THE AVAILABLE OPTIONS TO ESTABLISH A DRUG ASSIST-
 ANCE DEMONSTRATION PROGRAM, VARIOUS COST  SHARING  MODELS  FOR  ELIGIBLE
 PARTICIPANTS  AND  THE RELATED COSTS TO THE STATE ASSOCIATED WITH IMPLE-
 MENTING SUCH A PROGRAM NO LATER THAN JANUARY THIRTY-FIRST, TWO  THOUSAND
 TWENTY.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD13323-03-9

 A. 8533                             2
 
   § 279-B. EMERGENCY PRESCRIPTIONS. 1. A HEALTH CARE PRACTITIONER WHO IS
 AUTHORIZED   TO   PRESCRIBE   DRUGS  MAY  ISSUE  A  NON-PATIENT-SPECIFIC
 PRESCRIPTION FOR PHARMACISTS TO DISPENSE AN  EMERGENCY  PRESCRIPTION  TO
 REFILL  AN  EXPIRED  PRESCRIPTION  PURSUANT  TO  SUBDIVISION TWO OF THIS
 SECTION.
   2.  A  PHARMACIST  MAY DISPENSE INSULIN AND RELATED SUPPLIES, OR OTHER
 LIFE SUSTAINING, MAINTENANCE PRESCRIPTION MEDICATIONS IDENTIFIED BY  THE
 COMMISSIONER,  THROUGH  A NON-PATIENT SPECIFIC PRESCRIPTION, TO AN INDI-
 VIDUAL WHO HAS HAD A VALID PRESCRIPTION FOR  ANY  TYPE  OF  INSULIN,  OR
 OTHER  MEDICATIONS  IDENTIFIED  BY  THE  COMMISSIONER,  DURING THE PRIOR
 TWELVE MONTH PERIOD WHICH HAS  SINCE  EXPIRED,  ON  AN  EMERGENCY  BASIS
 PROVIDED THE PHARMACIST:
   (A)  FIRST  ATTEMPTS  TO  OBTAIN  AN AUTHORIZATION FROM THE AUTHORIZED
 PRESCRIBER AND CANNOT OBTAIN THE AUTHORIZATION;
   (B) BELIEVES, THAT IN  THE  PHARMACIST'S  PROFESSIONAL  JUDGMENT,  THE
 INTERRUPTION  OF  THE  THERAPY  REASONABLY  MIGHT PRODUCE AN UNDESIRABLE
 HEALTH CONSEQUENCE DETRIMENTAL TO THE PATIENT'S WELFARE OR  CAUSE  PHYS-
 ICAL OR MENTAL DISCOMFORT;
   (C)  PROVIDES  ONLY ONE REFILL OF THE PRESCRIPTION AND THE QUANTITY OF
 THAT REFILL IS IN CONFORMITY WITH THE PRESCRIBED DIRECTIONS FOR USE, BUT
 LIMITED TO AN AMOUNT NOT TO EXCEED A THIRTY-DAY EMERGENCY SUPPLY; AND
   (D) NOTIFIES, WITHIN SEVENTY-TWO HOURS OF DISPENSING THE  REFILL,  THE
 PRESCRIBER THAT AN EMERGENCY PRESCRIPTION HAS BEEN DISPENSED.
   §  2.  Subparagraph (B) of paragraph 15-a of subsection (i) of section
 3216 of the insurance law, as added by chapter 378 of the laws  of  1993
 and  such paragraph as renumbered by chapter 338 of the laws of 2003, is
 amended to read as follows:
   (B) Such coverage may be subject to annual deductibles and coinsurance
 as may be deemed appropriate by the superintendent and as are consistent
 with those  established  for  other  benefits  within  a  given  policy;
 PROVIDED  HOWEVER, THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED TO
 PAY OUT OF POCKET FOR A  COVERED  PRESCRIPTION  INSULIN  DRUG  SHALL  BE
 CAPPED  AT  AN  AMOUNT  NOT TO EXCEED ONE HUNDRED DOLLARS PER THIRTY-DAY
 SUPPLY, REGARDLESS OF THE AMOUNT OR TYPE OF INSULIN NEEDED TO FILL  SUCH
 COVERED  PERSON'S  PRESCRIPTION  AND REGARDLESS OF THE INSURED'S DEDUCT-
 IBLE, COPAYMENT, COINSURANCE, OUT OF POCKET MAXIMUM OR  ANY  OTHER  COST
 SHARING REQUIREMENT.
   §  3.  Subparagraph (B) of paragraph 7 of subsection k of section 3221
 of the insurance law, as amended by chapter 338 of the laws of 2003,  is
 amended to read as follows:
   (B) Such coverage may be subject to annual deductibles and coinsurance
 as may be deemed appropriate by the superintendent and as are consistent
 with  those  established  for  other  benefits  within  a  given policy;
 PROVIDED HOWEVER, THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED  TO
 PAY  OUT  OF  POCKET  FOR  A  COVERED PRESCRIPTION INSULIN DRUG SHALL BE
 CAPPED AT AN AMOUNT NOT TO EXCEED ONE  HUNDRED  DOLLARS  PER  THIRTY-DAY
 SUPPLY,  REGARDLESS OF THE AMOUNT OR TYPE OF INSULIN NEEDED TO FILL SUCH
 COVERED PERSON'S PRESCRIPTION AND REGARDLESS OF  THE  INSURED'S  DEDUCT-
 IBLE,  COPAYMENT,  COINSURANCE,  OUT OF POCKET MAXIMUM OR ANY OTHER COST
 SHARING REQUIREMENT.
   § 4. Paragraph 2 of subsection (u) of section 4303  of  the  insurance
 law,  as  amended by chapter 338 of the laws of 2003, is amended to read
 as follows:
   (2) Such coverage may be subject to annual deductibles and coinsurance
 as may be deemed appropriate by the superintendent and as are consistent
 with those  established  for  other  benefits  within  a  given  policy;

 A. 8533                             3
 
 PROVIDED  HOWEVER, THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED TO
 PAY OUT OF POCKET FOR A  COVERED  PRESCRIPTION  INSULIN  DRUG  SHALL  BE
 CAPPED  AT  AN  AMOUNT  NOT TO EXCEED ONE HUNDRED DOLLARS PER THIRTY-DAY
 SUPPLY,  REGARDLESS OF THE AMOUNT OR TYPE OF INSULIN NEEDED TO FILL SUCH
 COVERED PERSON'S PRESCRIPTION AND REGARDLESS OF  THE  INSURED'S  DEDUCT-
 IBLE,  COPAYMENT,  COINSURANCE,  OUT OF POCKET MAXIMUM OR ANY OTHER COST
 SHARING REQUIREMENT.
   § 5. This act shall take effect  immediately;  provided  however  that
 sections  two,  three  and four of this act shall take effect January 1,
 2020.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  8533--A
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              August 14, 2019
                                ___________
 
 Introduced  by  M.  of  A.  JOYNER,  O'DONNELL, LENTOL, WILLIAMS, REYES,
   SEAWRIGHT, SIMON, HEVESI, FERNANDEZ, DINOWITZ, BURKE, MOSLEY, DICKENS,
   L. ROSENTHAL,  ARROYO,  FALL,  SMITH,  McDONOUGH,  MONTESANO,   ORTIZ,
   COLTON,  THIELE,  JAFFEE,  GUNTHER,  CRUZ,  COOK,  MAGNARELLI, WALKER,
   CARROLL, DE LA ROSA, BLAKE, GRIFFIN, D'URSO, BRONSON, DenDEKKER, BENE-
   DETTO, SAYEGH, JACOBSON, STIRPE, MANKTELOW, GOTTFRIED,  BARRON,  OTIS,
   TAYLOR,  SIMOTAS  -- Multi-Sponsored by -- M. of A. BUCHWALD, TAGUE --
   read once and referred to the Committee on Health  --  recommitted  to
   the  Committee on Health in accordance with Assembly Rule 3, sec. 2 --
   committee discharged, bill amended, ordered reprinted as  amended  and
   recommitted to said committee
 
 AN  ACT  to  amend the public health law, in relation to drug assistance
   demonstration and emergency prescriptions; and to amend the  insurance
   law, in relation to capping cost sharing for insulin
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The public health law is amended by adding two new sections
 279-a and 279-b to read as follows:
   § 279-A. DRUG ASSISTANCE DEMONSTRATION PROGRAM. THE COMMISSIONER SHALL
 DEVELOP A DEMONSTRATION PROGRAM TO ENSURE ACCESS TO  INSULIN  AND  OTHER
 LIFE  SUSTAINING, MAINTENANCE PRESCRIPTION MEDICATIONS IDENTIFIED BY THE
 COMMISSIONER FOR RESIDENTS OF THE STATE WHO ARE UNINSURED, ARE  INELIGI-
 BLE FOR MEDICAID OR OTHER PUBLICLY FUNDED HEALTH COVERAGE, OR ARE OTHER-
 WISE  DETERMINED TO BE ELIGIBLE BY THE COMMISSIONER AND DEPEND UPON SUCH
 MEDICATION FOR THEIR SURVIVAL. IN DEVELOPING SUCH  PROGRAM  THE  COMMIS-
 SIONER SHALL:
   1.  CONSIDER MODELING THE DRUG ASSISTANCE DEMONSTRATION PROGRAM ON THE
 STATE'S HIV/AIDS DRUG ASSISTANCE PROGRAM PROVIDING  ACCESS  TO  ELIGIBLE
 INDIVIDUALS  AT  CERTAIN  INCOME  THRESHOLDS  ABOVE  THE FEDERAL POVERTY
 LEVEL;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13323-09-0
              

 A. 8533--A                          2
 
   2. ENGAGE  WITH  PHARMACEUTICAL  MANUFACTURERS  TO  EXPLORE  A  PUBLIC
 PRIVATE PARTNERSHIP DESIGNED TO BRING AFFORDABLE MEDICATIONS THROUGH THE
 DEMONSTRATION PROGRAM TO ELIGIBLE INDIVIDUALS; AND
   3.  REPORT TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE, THE
 SPEAKER OF THE ASSEMBLY, AND THE  CHAIRS  OF  THE  SENATE  AND  ASSEMBLY
 HEALTH  COMMITTEES  ON THE AVAILABLE OPTIONS TO ESTABLISH A DRUG ASSIST-
 ANCE DEMONSTRATION PROGRAM, VARIOUS COST  SHARING  MODELS  FOR  ELIGIBLE
 PARTICIPANTS  AND  THE RELATED COSTS TO THE STATE ASSOCIATED WITH IMPLE-
 MENTING SUCH A PROGRAM NO LATER THAN SIXTY DAYS AFTER THE EFFECTIVE DATE
 OF THIS SECTION.
   § 279-B. EMERGENCY PRESCRIPTIONS. 1. A HEALTH CARE PRACTITIONER WHO IS
 AUTHORIZED  TO  PRESCRIBE  DRUGS   MAY   ISSUE      NON-PATIENT-SPECIFIC
 PRESCRIPTIONS  FOR  PHARMACISTS TO DISPENSE   EMERGENCY PRESCRIPTIONS TO
 REFILL  EXPIRED  PRESCRIPTIONS  PURSUANT  TO  SUBDIVISION  TWO  OF  THIS
 SECTION.
   2.  A  PHARMACIST  MAY DISPENSE INSULIN AND RELATED SUPPLIES, OR OTHER
 LIFE SUSTAINING, MAINTENANCE PRESCRIPTION MEDICATIONS IDENTIFIED BY  THE
 COMMISSIONER, THROUGH NON-PATIENT-SPECIFIC PRESCRIPTIONS, TO AN INDIVID-
 UAL  WHO HAS HAD A VALID PRESCRIPTION FOR ANY TYPES OF INSULIN, OR OTHER
 MEDICATIONS IDENTIFIED BY THE  COMMISSIONER,  DURING  THE  PRIOR  TWELVE
 MONTH  PERIOD  WHICH  HAVE SINCE EXPIRED, ON AN EMERGENCY BASIS PROVIDED
 THE PHARMACIST:
   (A) FIRST ATTEMPTS TO OBTAIN  AN  AUTHORIZATION  FROM  THE  AUTHORIZED
 PRESCRIBER AND CANNOT OBTAIN THE AUTHORIZATION;
   (B)  BELIEVES,  THAT  IN  THE  PHARMACIST'S PROFESSIONAL JUDGMENT, THE
 INTERRUPTION OF THE THERAPY  REASONABLY  MIGHT  PRODUCE  AN  UNDESIRABLE
 HEALTH  CONSEQUENCE  DETRIMENTAL TO THE PATIENT'S WELFARE OR CAUSE PHYS-
 ICAL OR MENTAL DISCOMFORT;
   (C) PROVIDES REFILL OF THE PRESCRIPTION OR PRESCRIPTIONS AND THE QUAN-
 TITY OF THAT REFILL OR REFILLS IS  IN  CONFORMITY  WITH  THE  PRESCRIBED
 DIRECTIONS  FOR USE, BUT LIMITED TO AN AMOUNT NOT TO EXCEED A THIRTY-DAY
 EMERGENCY SUPPLY; AND
   (D) NOTIFIES, WITHIN SEVENTY-TWO HOURS OF  DISPENSING  THE  REFILL  OR
 REFILLS,  THE PRESCRIBER THAT AN EMERGENCY PRESCRIPTION OR PRESCRIPTIONS
 HAVE BEEN DISPENSED.
   § 2. Subparagraph (B) of paragraph 15-a of subsection (i)  of  section
 3216  of  the insurance law, as added by chapter 378 of the laws of 1993
 and such paragraph as renumbered by chapter 338 of the laws of 2003,  is
 amended to read as follows:
   (B) Such coverage may be subject to annual deductibles and coinsurance
 as may be deemed appropriate by the superintendent and as are consistent
 with  those  established  for  other  benefits  within  a  given policy;
 PROVIDED HOWEVER, THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED  TO
 PAY OUT OF POCKET FOR COVERED PRESCRIPTION INSULIN DRUGS SHALL BE CAPPED
 AT  AN  AMOUNT  NOT TO EXCEED ONE HUNDRED DOLLARS PER THIRTY-DAY SUPPLY,
 REGARDLESS OF THE AMOUNT OR TYPES OF INSULIN NEEDED TO FILL SUCH COVERED
 PERSON'S PRESCRIPTIONS  AND  REGARDLESS  OF  THE  INSURED'S  DEDUCTIBLE,
 COPAYMENT,  COINSURANCE, OUT OF POCKET MAXIMUM OR ANY OTHER COST SHARING
 REQUIREMENT.
   § 3. Subparagraph (B) of paragraph 7 of subsection (k) of section 3221
 of the insurance law, as amended by chapter 338 of the laws of 2003,  is
 amended to read as follows:
   (B) Such coverage may be subject to annual deductibles and coinsurance
 as may be deemed appropriate by the superintendent and as are consistent
 with  those  established  for  other  benefits  within  a  given policy;
 PROVIDED HOWEVER, THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED  TO

 A. 8533--A                          3
 
 PAY OUT OF POCKET FOR COVERED PRESCRIPTION INSULIN DRUGS SHALL BE CAPPED
 AT  AN  AMOUNT  NOT TO EXCEED ONE HUNDRED DOLLARS PER THIRTY-DAY SUPPLY,
 REGARDLESS OF THE AMOUNT OR TYPES OF INSULIN NEEDED TO FILL SUCH COVERED
 PERSON'S  PRESCRIPTIONS  AND  REGARDLESS  OF  THE  INSURED'S DEDUCTIBLE,
 COPAYMENT, COINSURANCE, OUT OF POCKET MAXIMUM OR ANY OTHER COST  SHARING
 REQUIREMENT.
   §  4.  Paragraph  2 of subsection (u) of section 4303 of the insurance
 law, as amended by chapter 338 of the laws of 2003, is amended  to  read
 as follows:
   (2) Such coverage may be subject to annual deductibles and coinsurance
 as may be deemed appropriate by the superintendent and as are consistent
 with  those  established  for  other  benefits  within  a  given policy;
 PROVIDED HOWEVER, THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED  TO
 PAY OUT OF POCKET FOR COVERED PRESCRIPTION INSULIN DRUGS SHALL BE CAPPED
 AT  AN  AMOUNT  NOT TO EXCEED ONE HUNDRED DOLLARS PER THIRTY-DAY SUPPLY,
 REGARDLESS OF THE AMOUNT OR TYPES OF INSULIN NEEDED TO FILL SUCH COVERED
 PERSON'S PRESCRIPTIONS  AND  REGARDLESS  OF  THE  INSURED'S  DEDUCTIBLE,
 COPAYMENT,  COINSURANCE, OUT OF POCKET MAXIMUM OR ANY OTHER COST SHARING
 REQUIREMENT.
   § 5. Subdivision 7 of section 4406-c of  the  public  health  law,  as
 added by chapter 536 of the laws of 2010, is amended to read as follows:
   7.  (I) No health maintenance organization which provides coverage for
 prescription drugs and for which cost-sharing, deductibles  or  co-insu-
 rance obligations are determined by category of prescription drugs shall
 impose  cost-sharing,  deductibles  or  co-insurance obligations for any
 prescription drug that exceeds the dollar amount of cost-sharing, deduc-
 tibles or co-insurance obligations for non-preferred brand drugs or  its
 equivalent (or brand drugs if there is no non-preferred brand drug cate-
 gory).
   (II)  THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED TO PAY OUT OF
 POCKET FOR COVERED PRESCRIPTION INSULIN DRUGS  SHALL  BE  CAPPED  AT  AN
 AMOUNT  NOT TO EXCEED ONE HUNDRED DOLLARS PER THIRTY-DAY SUPPLY, REGARD-
 LESS OF THE AMOUNT OR TYPES OF  INSULIN  NEEDED  TO  FILL  SUCH  COVERED
 PERSON'S  PRESCRIPTIONS  AND  REGARDLESS  OF  THE  INSURED'S DEDUCTIBLE,
 COPAYMENT, COINSURANCE, OUT OF POCKET MAXIMUM OR ANY OTHER COST  SHARING
 REQUIREMENT.
   §  6.  This  act  shall take effect immediately; provided however that
 sections two, three, four and five of this act shall take effect January
 1, 2021.