NY State Senate Bill 2019-S2849

Archive: Last Bill Status Via A2969 - Vetoed by Governor

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

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Dec 23, 2019	tabled vetoed memo.245
Dec 17, 2019	delivered to governor
Jun 19, 2019	returned to assembly passed senate 3rd reading cal.462 substituted for s2849a
Jun 19, 2019	substituted by a2969a
Jun 11, 2019	amended on third reading 2849a
May 01, 2019	advanced to third reading
Apr 30, 2019	2nd report cal.
Apr 29, 2019	1st report cal.462
Jan 29, 2019	referred to insurance

Votes

- Jun 19, 2019 - Floor Vote
  A2969
  
  56
  
  Aye
  
  6
  
  Nay
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Floor Vote: Jun 19, 2019
      
      aye (56)
      
      Addabbo Jr.
      
      Amedore
      
      Antonacci
      
      Bailey
      
      Benjamin
      
      Biaggi
      
      Boyle
      
      Breslin
      
      Brooks
      
      Carlucci
      
      Comrie
      
      Felder
      
      Funke
      
      Gaughran
      
      Gianaris
      
      Gounardes
      
      Griffo
      
      Harckham
      
      Helming
      
      Hoylman-Sigal
      
      Jackson
      
      Jacobs
      
      Jordan
      
      Kaminsky
      
      Kaplan
      
      Kavanagh
      
      Kennedy
      
      Krueger
      
      LaValle
      
      Lanza
      
      Little
      
      Liu
      
      Martinez
      
      May
      
      Mayer
      
      Metzger
      
      Montgomery
      
      Myrie
      
      Parker
      
      Persaud
      
      Ramos
      
      Ranzenhofer
      
      Ritchie
      
      Rivera
      
      Robach
      
      Salazar
      
      Sanders Jr.
      
      Savino
      
      Sepúlveda
      
      Serino
      
      Serrano
      
      Skoufis
      
      Stavisky
      
      Stewart-Cousins
      
      Tedisco
      
      Thomas
      
      nay (6)
      
      Akshar
      
      Flanagan
      
      Gallivan
      
      O'Mara
      
      Ortt
      
      Seward
  Apr 29, 2019 - Insurance Committee Vote
  S2849
  
  10
  
  Aye
  
  0
  
  Nay
  
  1
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Insurance Committee Vote: Apr 29, 2019
      
      aye (10)
      
      Breslin
      
      Brooks
      
      Carlucci
      
      Kennedy
      
      Martinez
      
      Ortt
      
      Parker
      
      Ranzenhofer
      
      Sanders Jr.
      
      Serino
      
      aye wr (1)
      
      Seward

Bill Amendments

Original

A (Active)

co-Sponsors

View additional co-sponsors

2019-S2849 - Details

Law Section:: Insurance Law
Laws Affected:: Add §4909, Ins L; add §4909, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2015-2016: S5382
2017-2018: S5022

2019-S2849 - Summary

Prohibits a health care plan from making prescription drug formulary changes during a contract year.

2019-S2849 - Sponsor Memo

                                
 
BILL NUMBER: S2849

SPONSOR: BRESLIN
 
TITLE OF BILL:

An act to amend the insurance law and the public health law, in relation
to prescription drug formulary changes during a contract year

 
PURPOSE:

To clarify that health insurance consumers are protected from adverse
effects of mid-year formulary changes.

 
SUMMARY OF PROVISIONS:

Section 1 creates a new section 4909 of the Insurance Law to add
restrictions to drug formulary changes. If the plan's drug formulary has
two or more tiers of drug benefits with different deductibles, copay-
ments or coinsurance, the plan may not move a drug to a tier with higher
patient cost sharing during the enrollment year. Additionally, the plan
may not add new utilization management restrictions to a formulary drug,

unless such changes occur at the time of enrollment or issuance of
coverage, and must provide notice to policyholders of certain changes to
a formulary in an upcoming plan year. A health care plan may move a
prescription drug to a tier with a larger copayment, coinsurance and
different deductible if an AB-rated generic equivalent drug or inter
changeable biological equivalent is added to the formulary at the same-
time. A prescription drug may be removed from a formulary if the federal
Food and Drug Administration determines that such drug should be removed
from the market, including new utilization management restrictions aris-
ing from safety concerns.

Section 2 adds a new section 4909 of the Public Health Law to add simi-
lar provisions as Section 1 of this act.

Section 3 provides that this act would take effect on the 60th day after
enactment, provided that effective immediately the superintendent of
insurance may make regulations and take other actions necessary to
implement the act.

 
JUSTIFICATION:

The purpose of the bill is to ensure that health insurance enrollees
have assurance that their health plan will maintain continuity in cover-
age for their prescription drugs during the course of the enrollment
year. Enrollees choose health exchange plans based on the formulary
status of a necessary therapy. Not only can these unexpected formulary
changes be extremely financially burdensome, a change in prescription
drug availability could result in serious medical problems for the
enrollee.

 
LEGISLATIVE HISTORY:

2018: S.5022c - Referred to Insurance
2016: S.5382a - Referred to Insurance

 
FISCAL IMPLICATIONS:

None.
 
EFFECTIVE DATE:
This act shall take effect on the sixtieth day after it shall have
become a law. Effective immediately, the addition, amendment and/or
repeal of any rule or regulation necessary for the implementation of
this act on its effective date are authorized to be made and completed
on or before such effective date.

2019-S2849 - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2849
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                             January 29, 2019
                                ___________
 
 Introduced  by Sens. BRESLIN, ADDABBO, AKSHAR, BROOKS, CARLUCCI, COMRIE,
   GRIFFO, HELMING, JACOBS, KAMINSKY, KENNEDY, KRUEGER,  LANZA,  LAVALLE,
   MAYER,   ORTT,  PARKER,  RITCHIE,  RIVERA,  ROBACH,  SANDERS,  SAVINO,
   SEPULVEDA, SERINO -- read twice and ordered printed, and when  printed
   to be committed to the Committee on Insurance

 AN ACT to amend the insurance law and the public health law, in relation
   to prescription drug formulary changes during a contract year
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The insurance law is amended by adding a new  section  4909
 to read as follows:
   §  4909.  PRESCRIPTION DRUG FORMULARY CHANGES. (A) EXCEPT AS OTHERWISE
 PROVIDED IN SUBSECTION (C) OF THIS SECTION, A  HEALTH  CARE  PLAN  SHALL
 NOT:
   (I) REMOVE A PRESCRIPTION DRUG FROM A FORMULARY;
   (II)  MOVE  A  PRESCRIPTION  DRUG  TO A TIER WITH A LARGER DEDUCTIBLE,
 COPAYMENT, OR COINSURANCE IF THE FORMULARY INCLUDES TWO OR MORE TIERS OF
 BENEFITS PROVIDING FOR DIFFERENT DEDUCTIBLES, COPAYMENTS OR  COINSURANCE
 APPLICABLE TO THE PRESCRIPTION DRUGS IN EACH TIER; OR
   (III)  ADD  UTILIZATION MANAGEMENT RESTRICTIONS TO A PRESCRIPTION DRUG
 ON A FORMULARY, UNLESS SUCH CHANGES OCCUR AT THE TIME OF  ENROLLMENT  OR
 ISSUANCE OF COVERAGE.
   (B)  PROHIBITIONS  PROVIDED  IN  SUBSECTION  (A) OF THIS SECTION SHALL
 APPLY BEGINNING ON THE DATE ON WHICH OPEN ENROLLMENT BEGINS FOR  A  PLAN
 YEAR  AND THROUGH THE END OF THE PLAN YEAR TO WHICH SUCH OPEN ENROLLMENT
 PERIOD APPLIES.
   (C) (I) A HEALTH CARE PLAN WITH A FORMULARY THAT INCLUDES TWO OR  MORE
 TIERS  OF  BENEFITS  PROVIDING  FOR DIFFERENT DEDUCTIBLES, COPAYMENTS OR
 COINSURANCE APPLICABLE TO PRESCRIPTION DRUGS IN EACH  TIER  MAY  MOVE  A
 PRESCRIPTION DRUG TO A TIER WITH A LARGER DEDUCTIBLE, COPAYMENT OR COIN-
 SURANCE  IF AN AB-RATED GENERIC EQUIVALENT OR INTERCHANGEABLE BIOLOGICAL
 PRODUCT FOR SUCH PRESCRIPTION DRUG IS ADDED TO THE FORMULARY AT THE SAME
 TIME.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04720-01-9

 S. 2849                             2
 
   (II) A HEALTH CARE PLAN MAY REMOVE A PRESCRIPTION DRUG FROM  A  FORMU-
 LARY  IF  THE  FEDERAL FOOD AND DRUG ADMINISTRATION DETERMINES THAT SUCH
 PRESCRIPTION DRUG SHOULD BE  REMOVED  FROM  THE  MARKET,  INCLUDING  NEW
 UTILIZATION  MANAGEMENT RESTRICTIONS ISSUED PURSUANT TO FEDERAL FOOD AND
 DRUG ADMINISTRATION SAFETY CONCERNS.
   (D)  A  HEALTH  CARE PLAN SHALL PROVIDE NOTICE TO POLICYHOLDERS OF THE
 INTENT TO REMOVE A PRESCRIPTION DRUG FROM A FORMULARY OR  ALTER  DEDUCT-
 IBLE,  COPAYMENT  OR COINSURANCE REQUIREMENTS IN THE UPCOMING PLAN YEAR,
 THIRTY DAYS PRIOR TO THE OPEN ENROLLMENT PERIOD FOR THE CONSECUTIVE PLAN
 YEAR. SUCH NOTICE OF IMPENDING FORMULARY AND  DEDUCTIBLE,  COPAYMENT  OR
 COINSURANCE  CHANGES SHALL ALSO BE POSTED ON THE PLAN'S ONLINE FORMULARY
 AND IN ANY PRESCRIPTION DRUG FINDER SYSTEM THAT THE PLAN PROVIDES TO THE
 PUBLIC.
   § 2. The public health law is amended by adding a new section 4909  to
 read as follows:
   §  4909.  PRESCRIPTION  DRUG FORMULARY CHANGES. 1. EXCEPT AS OTHERWISE
 PROVIDED IN SUBDIVISION THREE OF THIS SECTION, A HEALTH CARE PLAN  SHALL
 NOT:
   (A) REMOVE A PRESCRIPTION DRUG FROM A FORMULARY;
   (B)  MOVE  A  PRESCRIPTION  DRUG  TO  A TIER WITH A LARGER DEDUCTIBLE,
 COPAYMENT, OR COINSURANCE IF THE FORMULARY INCLUDES TWO OR MORE TIERS OF
 BENEFITS PROVIDING FOR DIFFERENT DEDUCTIBLES, COPAYMENTS OR  COINSURANCE
 APPLICABLE TO THE PRESCRIPTION DRUGS IN EACH TIER; OR
   (C)  ADD UTILIZATION MANAGEMENT RESTRICTIONS TO A PRESCRIPTION DRUG ON
 A FORMULARY, UNLESS SUCH CHANGES OCCUR AT  THE  TIME  OF  ENROLLMENT  OR
 ISSUANCE OF COVERAGE.
   2.  PROHIBITIONS  PROVIDED  IN  SUBDIVISION  ONE OF THIS SECTION SHALL
 APPLY BEGINNING ON THE DATE ON WHICH OPEN ENROLLMENT BEGINS FOR  A  PLAN
 YEAR  AND THROUGH THE END OF THE PLAN YEAR TO WHICH SUCH OPEN ENROLLMENT
 PERIOD APPLIES.
   3. (A) A HEALTH CARE PLAN WITH A FORMULARY THAT INCLUDES TWO  OR  MORE
 TIERS  OF  BENEFITS  PROVIDING  FOR DIFFERENT DEDUCTIBLES, COPAYMENTS OR
 COINSURANCE APPLICABLE TO PRESCRIPTION DRUGS IN EACH  TIER  MAY  MOVE  A
 PRESCRIPTION DRUG TO A TIER WITH A LARGER DEDUCTIBLE, COPAYMENT OR COIN-
 SURANCE  IF AN AB-RATED GENERIC EQUIVALENT OR INTERCHANGEABLE BIOLOGICAL
 PRODUCT FOR SUCH PRESCRIPTION DRUG IS ADDED TO THE FORMULARY AT THE SAME
 TIME.
   (B) A HEALTH CARE PLAN MAY REMOVE A PRESCRIPTION DRUG FROM A FORMULARY
 IF THE  FEDERAL  FOOD  AND  DRUG  ADMINISTRATION  DETERMINES  THAT  SUCH
 PRESCRIPTION  DRUG  SHOULD  BE  REMOVED  FROM  THE MARKET, INCLUDING NEW
 UTILIZATION MANAGEMENT RESTRICTIONS ISSUED PURSUANT TO FEDERAL FOOD  AND
 DRUG ADMINISTRATION SAFETY CONCERNS.
   4.  A  HEALTH  CARE  PLAN SHALL PROVIDE NOTICE TO POLICYHOLDERS OF THE
 INTENT TO REMOVE A PRESCRIPTION DRUG FROM A FORMULARY OR  ALTER  DEDUCT-
 IBLE,  COPAYMENT  OR COINSURANCE REQUIREMENTS IN THE UPCOMING PLAN YEAR,
 THIRTY DAYS PRIOR TO THE OPEN ENROLLMENT PERIOD FOR THE CONSECUTIVE PLAN
 YEAR. SUCH NOTICE OF IMPENDING FORMULARY AND  DEDUCTIBLE,  COPAYMENT  OR
 COINSURANCE  CHANGES SHALL ALSO BE POSTED ON THE PLAN'S ONLINE FORMULARY
 AND IN ANY PRESCRIPTION DRUG FINDER SYSTEM THAT THE PLAN PROVIDES TO THE
 PUBLIC.
   § 3. This act shall take effect on the sixtieth  day  after  it  shall
 have  become  a  law.    Effective  immediately, the addition, amendment
 and/or repeal of any rule or regulation necessary for the implementation
 of this act on  its  effective  date  are  authorized  to  be  made  and
 completed on or before such effective date.

co-Sponsors

View additional co-sponsors

2019-S2849A (ACTIVE) - Details

Law Section:: Insurance Law
Laws Affected:: Add §4909, Ins L; add §4909, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2015-2016: S5382
2017-2018: S5022

2019-S2849A (ACTIVE) - Summary

Prohibits a health care plan from making prescription drug formulary changes during a contract year.

2019-S2849A (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S2849A

SPONSOR: BRESLIN
 
TITLE OF BILL:  An act to amend the insurance law and the public
health law, in relation to prescription drug formulary changes during a
contract year

 
PURPOSE OR GENERAL IDEA OF BILL:

To clarify that health insurance consumers covered by plans that are
required to offer essential health benefits under the affordable care
act are protected from adverse effects of mid-year formulary changes,
and properly notified of formulary changes.

 
SUMMARY OF PROVISIONS:

Section 1 adds a new section 4909 to the Insurance Law to state that a
health care plan which provides essential health benefits under the
federal affordable care act may not remove a prescription drug from a
formulary during the enrollment year. If the plan's drug formulary has
two or more tiers of drug benefits with different deductibles, copay-

ments or coinsurance, the plan may not move a drug to a tier with higher
patient cost sharing during the enrollment year. The plan may also not
add new or additional formulary restrictions during the enrollment year.
A health care plan may move a prescription drug to a tier with a larger
copayment, coinsurance and different deductible if an AB-rated generic
equivalent drug or interchangeable biological product is added to the
formulary at the same time. In addition, provide notice to policyholders
of the intent to remove a prescription drugs from a formulary or alter
deductible, copayment or coinsurance requirements in the upcoming plan
year, thirty days prior to the open enrollment period for the consec-
utive plan year. This section also provides that terms of a collective
bargaining agreement shall not be superseded.

Section 2 adds a new section 4909 to the public health law to also state
that a health care plan which provides essential health benefits under
the federal affordable care act may not remove a prescription drug from
a formulary during the enrollment year. If the plan's drug formulary has
two or more tiers of drug benefits with different deductibles, copay-
ments or coinsurance, the plan may not move a drug to a tier with higher
patient cost sharing during the enrollment year. The plan may also not
add new or additional formulary restrictions during the enrollment year
A health care plan may move a prescription drug to a tier with a larger
copayment, coinsurance and different deductible if an AB-rated generic
equivalent drug or interchangeable biological product is added to the
formulary at the same time. In addition, provide notice to policyholders
of the intent to remove a prescription drugs from a formulary or alter
deductible, copayment or coinsurance requirements in the upcoming plan
year, thirty days prior to the open enrollment period for the consec-
utive plan year. This section also provides that terms of a collective
bargaining agreement shall not be superseded.

Section 3 provides that this act would take effect on the 60th day after
enactment, provided that effective immediately the superintendent of
insurance may make regulations and take other actions necessary to
implement the act.

 
DIFFERENCE BETWEEN ORIGINAL AND AMENDED VERSION (IF APPLICABLE):

The amendments to this bill clarify that this act shall not supersede a
collective bargaining agreement or the rights of labor organizations to
collectively bargain changes to formularies.

 
JUSTIFICATION:

This bill ensures that enrollees who select a health exchange plan based
on their individual prescription drug needs have assurance that the
health plan will maintain continuity in coverage for those prescription
drugs during the course of the enrollment year, and be provided adequate
notice of the intent to remove a prescription on the upcoming plan year.
Enrollees choose health exchange plans based on the formulary status of
a necessary therapy.

A change in prescription drug availability could result in serious
medical problems for the enrollee. Also, these unexpected formulary
changes can be extremely financially burdensome and have negative health
outcomes.

 
PRIOR LEGISLATIVE HISTORY:

A.2317-C of 2017/2018;
A.7707A of 2015/2016
2018: S.5022c - Referred to Insurance
2016: S.5382a - Referred to Insurance

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

None.

 
EFFECTIVE DATE:
This act shall take effect on the sixtieth day after it shall have
become a law; provided, however, that effective immediately, the addi-
tion, amendment and/or repeal of any rule or regulation necessary for
the implementation of this act on its effective date are authorized to
be made and completed by the superintendent of financial services on or
before such date.

2019-S2849A (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  2849--A
     Cal. No. 462
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                             January 29, 2019
                                ___________
 
 Introduced  by Sens. BRESLIN, ADDABBO, AKSHAR, BENJAMIN, BIAGGI, BROOKS,
   CARLUCCI, COMRIE, FUNKE, GALLIVAN, GAUGHRAN, GIANARIS,  GRIFFO,  HELM-
   ING,  HOYLMAN,  JACOBS,  JORDAN,  KAMINSKY,  KENNEDY,  KRUEGER, LANZA,
   LAVALLE, MAY, MAYER, ORTT, PARKER, RITCHIE, RIVERA,  ROBACH,  SALAZAR,
   SANDERS,  SAVINO,  SEPULVEDA, SERINO, SERRANO, SKOUFIS, THOMAS -- read
   twice and ordered printed, and when printed to  be  committed  to  the
   Committee  on  Insurance  --  reported  favorably from said committee,
   ordered to first and  second  report,  ordered  to  a  third  reading,
   amended  and  ordered  reprinted,  retaining its place in the order of
   third reading
 
 AN ACT to amend the insurance law and the public health law, in relation
   to prescription drug formulary changes during a contract year
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  The insurance law is amended by adding a new section 4909
 to read as follows:
   § 4909. PRESCRIPTION DRUG FORMULARY CHANGES. (A) EXCEPT  AS  OTHERWISE
 PROVIDED  IN  SUBSECTION  (C)  OF THIS SECTION, A HEALTH CARE PLAN SHALL
 NOT:
   (I) REMOVE A PRESCRIPTION DRUG FROM A FORMULARY;
   (II) MOVE A PRESCRIPTION DRUG TO A  TIER  WITH  A  LARGER  DEDUCTIBLE,
 COPAYMENT, OR COINSURANCE IF THE FORMULARY INCLUDES TWO OR MORE TIERS OF
 BENEFITS  PROVIDING FOR DIFFERENT DEDUCTIBLES, COPAYMENTS OR COINSURANCE
 APPLICABLE TO THE PRESCRIPTION DRUGS IN EACH TIER; OR
   (III) ADD UTILIZATION MANAGEMENT RESTRICTIONS TO A  PRESCRIPTION  DRUG
 ON  A  FORMULARY, UNLESS SUCH CHANGES OCCUR AT THE TIME OF ENROLLMENT OR
 ISSUANCE OF COVERAGE.
   (B) PROHIBITIONS PROVIDED IN SUBSECTION  (A)  OF  THIS  SECTION  SHALL
 APPLY  BEGINNING  ON THE DATE ON WHICH OPEN ENROLLMENT BEGINS FOR A PLAN
 YEAR AND THROUGH THE END OF THE PLAN YEAR TO WHICH SUCH OPEN  ENROLLMENT
 PERIOD APPLIES.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD04720-05-9

 S. 2849--A                          2
 
   (C)  (I) A HEALTH CARE PLAN WITH A FORMULARY THAT INCLUDES TWO OR MORE
 TIERS OF BENEFITS PROVIDING FOR  DIFFERENT  DEDUCTIBLES,  COPAYMENTS  OR
 COINSURANCE  APPLICABLE  TO  PRESCRIPTION  DRUGS IN EACH TIER MAY MOVE A
 PRESCRIPTION DRUG TO A TIER WITH A LARGER DEDUCTIBLE, COPAYMENT OR COIN-
 SURANCE  IF AN AB-RATED GENERIC EQUIVALENT OR INTERCHANGEABLE BIOLOGICAL
 PRODUCT FOR SUCH PRESCRIPTION DRUG IS ADDED TO THE FORMULARY AT THE SAME
 TIME.
   (II) A HEALTH CARE PLAN MAY REMOVE A PRESCRIPTION DRUG FROM  A  FORMU-
 LARY  IF  THE  FEDERAL FOOD AND DRUG ADMINISTRATION DETERMINES THAT SUCH
 PRESCRIPTION DRUG SHOULD BE  REMOVED  FROM  THE  MARKET,  INCLUDING  NEW
 UTILIZATION  MANAGEMENT RESTRICTIONS ISSUED PURSUANT TO FEDERAL FOOD AND
 DRUG ADMINISTRATION SAFETY CONCERNS.
   (D) A HEALTH CARE PLAN SHALL PROVIDE NOTICE TO  POLICYHOLDERS  OF  THE
 INTENT  TO  REMOVE A PRESCRIPTION DRUG FROM A FORMULARY OR ALTER DEDUCT-
 IBLE, COPAYMENT OR COINSURANCE REQUIREMENTS IN THE UPCOMING  PLAN  YEAR,
 THIRTY DAYS PRIOR TO THE OPEN ENROLLMENT PERIOD FOR THE CONSECUTIVE PLAN
 YEAR.  SUCH  NOTICE  OF IMPENDING FORMULARY AND DEDUCTIBLE, COPAYMENT OR
 COINSURANCE CHANGES SHALL ALSO BE POSTED ON THE PLAN'S ONLINE  FORMULARY
 AND IN ANY PRESCRIPTION DRUG FINDER SYSTEM THAT THE PLAN PROVIDES TO THE
 PUBLIC.
   (E)  THE PROVISIONS OF THIS SECTION SHALL NOT SUPERSEDE THE TERMS OF A
 COLLECTIVE BARGAINING AGREEMENT, OR THE RIGHTS OF  LABOR  REPRESENTATION
 GROUPS TO COLLECTIVELY BARGAIN CHANGES TO THE FORMULARIES.
   §  2. The public health law is amended by adding a new section 4909 to
 read as follows:
   § 4909. PRESCRIPTION DRUG FORMULARY CHANGES. 1.  EXCEPT  AS  OTHERWISE
 PROVIDED  IN SUBDIVISION THREE OF THIS SECTION, A HEALTH CARE PLAN SHALL
 NOT:
   (A) REMOVE A PRESCRIPTION DRUG FROM A FORMULARY;
   (B) MOVE A PRESCRIPTION DRUG TO  A  TIER  WITH  A  LARGER  DEDUCTIBLE,
 COPAYMENT, OR COINSURANCE IF THE FORMULARY INCLUDES TWO OR MORE TIERS OF
 BENEFITS  PROVIDING FOR DIFFERENT DEDUCTIBLES, COPAYMENTS OR COINSURANCE
 APPLICABLE TO THE PRESCRIPTION DRUGS IN EACH TIER; OR
   (C) ADD UTILIZATION MANAGEMENT RESTRICTIONS TO A PRESCRIPTION DRUG  ON
 A  FORMULARY,  UNLESS  SUCH  CHANGES  OCCUR AT THE TIME OF ENROLLMENT OR
 ISSUANCE OF COVERAGE.
   2. PROHIBITIONS PROVIDED IN SUBDIVISION  ONE  OF  THIS  SECTION  SHALL
 APPLY  BEGINNING  ON THE DATE ON WHICH OPEN ENROLLMENT BEGINS FOR A PLAN
 YEAR AND THROUGH THE END OF THE PLAN YEAR TO WHICH SUCH OPEN  ENROLLMENT
 PERIOD APPLIES.
   3.  (A)  A HEALTH CARE PLAN WITH A FORMULARY THAT INCLUDES TWO OR MORE
 TIERS OF BENEFITS PROVIDING FOR  DIFFERENT  DEDUCTIBLES,  COPAYMENTS  OR
 COINSURANCE  APPLICABLE  TO  PRESCRIPTION  DRUGS IN EACH TIER MAY MOVE A
 PRESCRIPTION DRUG TO A TIER WITH A LARGER DEDUCTIBLE, COPAYMENT OR COIN-
 SURANCE IF AN AB-RATED GENERIC EQUIVALENT OR INTERCHANGEABLE  BIOLOGICAL
 PRODUCT FOR SUCH PRESCRIPTION DRUG IS ADDED TO THE FORMULARY AT THE SAME
 TIME.
   (B) A HEALTH CARE PLAN MAY REMOVE A PRESCRIPTION DRUG FROM A FORMULARY
 IF  THE  FEDERAL  FOOD  AND  DRUG  ADMINISTRATION  DETERMINES  THAT SUCH
 PRESCRIPTION DRUG SHOULD BE  REMOVED  FROM  THE  MARKET,  INCLUDING  NEW
 UTILIZATION  MANAGEMENT RESTRICTIONS ISSUED PURSUANT TO FEDERAL FOOD AND
 DRUG ADMINISTRATION SAFETY CONCERNS.
   4. A HEALTH CARE PLAN SHALL PROVIDE NOTICE  TO  POLICYHOLDERS  OF  THE
 INTENT  TO  REMOVE A PRESCRIPTION DRUG FROM A FORMULARY OR ALTER DEDUCT-
 IBLE, COPAYMENT OR COINSURANCE REQUIREMENTS IN THE UPCOMING  PLAN  YEAR,
 THIRTY DAYS PRIOR TO THE OPEN ENROLLMENT PERIOD FOR THE CONSECUTIVE PLAN

 S. 2849--A                          3
 
 YEAR.  SUCH  NOTICE  OF IMPENDING FORMULARY AND DEDUCTIBLE, COPAYMENT OR
 COINSURANCE CHANGES SHALL ALSO BE POSTED ON THE PLAN'S ONLINE  FORMULARY
 AND IN ANY PRESCRIPTION DRUG FINDER SYSTEM THAT THE PLAN PROVIDES TO THE
 PUBLIC.
   5.  THE  PROVISIONS OF THIS SECTION SHALL NOT SUPERSEDE THE TERMS OF A
 COLLECTIVE BARGAINING AGREEMENT, OR THE RIGHTS OF  LABOR  REPRESENTATION
 GROUPS TO COLLECTIVELY BARGAIN CHANGES TO THE FORMULARIES.
   §  3.  This  act  shall take effect on the sixtieth day after it shall
 have become a law.    Effective  immediately,  the  addition,  amendment
 and/or repeal of any rule or regulation necessary for the implementation
 of  this  act  on  its  effective  date  are  authorized  to be made and
 completed on or before such effective date.

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Senate Bill S2849

Sponsored By

Archive: Last Bill Status Via A2969 - Vetoed by Governor

Jun 19, 2019 - Floor Vote

Floor Vote: Jun 19, 2019

Apr 29, 2019 - Insurance Committee Vote

Insurance Committee Vote: Apr 29, 2019

Bill Amendments

co-Sponsors

2019-S2849 - Details

2019-S2849 - Summary

2019-S2849 - Sponsor Memo

2019-S2849 - Bill Text download pdf

co-Sponsors

2019-S2849A (ACTIVE) - Details

2019-S2849A (ACTIVE) - Summary

2019-S2849A (ACTIVE) - Sponsor Memo

2019-S2849A (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S2849

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Sponsored By

Archive: Last Bill Status Via A2969 - Vetoed by Governor

Bill Amendments

co-Sponsors

2019-S2849 - Details

2019-S2849 - Summary

2019-S2849 - Sponsor Memo

2019-S2849 - Bill Text download pdf

co-Sponsors

2019-S2849A (ACTIVE) - Details

2019-S2849A (ACTIVE) - Summary

2019-S2849A (ACTIVE) - Sponsor Memo

2019-S2849A (ACTIVE) - Bill Text download pdf

Comments