NY State Senate Bill 2019-S6296

Senate Bill S6296

2019-2020 Legislative Session

Provides that prescriptions covered by insurance, that would otherwise be required to be filled by mail order, may be filled at a retail pharmacy under certain circumstances

download bill text pdf

Archive: Last Bill Status - In Senate Committee Insurance 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

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 08, 2020	referred to insurance
Jun 03, 2019	referred to rules

2019-S6296 (ACTIVE) - Details

See Assembly Version of this Bill:: A347
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2015-2016: A10290
2017-2018: A1929
2021-2022: S1772, A5787
2023-2024: S3370

2019-S6296 (ACTIVE) - Summary

Provides that prescriptions covered by insurance, that would otherwise be required to be filled by mail order, may be filled at a retail pharmacy under certain circumstances.

2019-S6296 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S6296

SPONSOR: SKOUFIS
 
TITLE OF BILL:  An act to amend the insurance law, in relation to
coverage of prescriptions obtained by mail order or at a non-retail
pharmacy

 
PURPOSE OR GENERAL IDEA OF BILL:

Ensure patient access to retail pharmacies upon the prescriber's deter-
mination that mail order delivery would not be appropriate

 
SUMMARY OF PROVISIONS:

Sections one, two and three amend Insurance Law §§ 3216, 3221 and 4303
respectively to provide that a prescriber, after consultation with the
patient's insurer, may determine that mail order delivery of
prescription medication is not appropriate given the patient's resi-
dence, medical condition, storage requirements of the drug, availability
of the insured to receive the prescription or the patient's ability to
understand guidance and support over the telephone. Provided the retail

pharmacy agrees to the same reimbursement amount and is able to fill the
prescription, the prescriber's determination shall be final.

Section four provides that the act take effect immediately.

 
JUSTIFICATION:

While recognizing the value of mail order pharmacies and the convenience
they provide for many, not all patients have the same needs. For many
patients, especially those with complex medical conditions, access to
local pharmacies for their medications can be essential for their health
and wellbeing. Patients may have residences lacking secure deliver
locations, be on specific treatment regimens that may be disrupted if
the medications are not promptly received, take medications that need
special handling, or need the in person counseling of a pharmacist.
There are many different reasons why an individual may benefit from
access to a retail pharmacy rather than a mail order pharmacy. That
decision should be made between the patient and his or her prescriber.
The Legislature has already acknowledged the need to ensure patient
access to pharmacy options.  This legislation will expand upon the 2011
provisions to ensure a prescriber, considering all factors relevant to
the patient, can determine when mail order is not appropriate. The bill
also ensures that cost is not affected, by requiring the retail pharmacy
to agree to the same reimbursement amount.

 
PRIOR LEGISLATIVE HISTORY:

Assembly
2016 (Al 0290A) - Referred to Insurance 2017-18 (A1929) - Referred to
Insurance
Senate
2016 (A7595A) - Referred to Insurance

 
FISCAL IMPLICATIONS:

None to the state

 
EFFECTIVE DATE:
This act shall take effect immediately.

2019-S6296 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6296
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                               June 3, 2019
                                ___________
 
 Introduced  by  Sen. SKOUFIS -- read twice and ordered printed, and when
   printed to be committed to the Committee on Rules
 
 AN  ACT  to  amend  the  insurance  law,  in  relation  to  coverage  of
   prescriptions obtained by mail order or at a non-retail pharmacy
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The opening paragraph of paragraph 28 of subsection (i)  of
 section  3216  of the insurance law, as added by chapter 589 of the laws
 of 2011, is designated subparagraph (A) and a new  subparagraph  (B)  is
 added to read as follows:
   (B)  NOTWITHSTANDING ANY OTHER PROVISION OF THIS PARAGRAPH, IF A PRES-
 CRIBER, AFTER CONSULTING WITH THE INSURER REGARDING THE  APPROPRIATENESS
 OF  MAIL ORDER DELIVERY GIVEN: (I) THE RESIDENCE OR DELIVERY LOCATION OF
 THE INSURED; (II) THE MEDICAL CONDITION OF THE INSURED; (III) THE  STOR-
 AGE  REQUIREMENTS  OF  THE DRUG; (IV) THE AVAILABILITY OF THE INSURED TO
 RECEIVE THE PRESCRIPTION; OR (V) THE  INSURED'S  ABILITY  TO  COMPREHEND
 PHARMACEUTICAL  GUIDANCE AND SUPPORT OVER THE TELEPHONE, DETERMINES THAT
 A DRUG AS PRESCRIBED ON AN INDIVIDUAL BASIS IS MOST APPROPRIATELY FILLED
 AT A RETAIL LOCATION, PROVIDED THAT AN IN-NETWORK RETAIL PHARMACY OF THE
 PATIENT'S CHOOSING AGREES TO THE SAME REIMBURSEMENT AMOUNT AND  IS  ABLE
 TO FILL THE PRESCRIPTION, THE PRESCRIBER'S DETERMINATION SHALL BE FINAL.
   §  2.  The  opening  paragraph  of  paragraph  18 of subsection (l) of
 section 3221 of the insurance law is designated subparagraph (A)  and  a
 new subparagraph (B) is added to read as follows:
   (B)  NOTWITHSTANDING ANY OTHER PROVISION OF THIS PARAGRAPH, IF A PRES-
 CRIBER, AFTER CONSULTING WITH THE INSURER REGARDING THE  APPROPRIATENESS
 OF  MAIL ORDER DELIVERY GIVEN: (I) THE RESIDENCE OR DELIVERY LOCATION OF
 THE INSURED; (II) THE MEDICAL CONDITION OF THE INSURED; (III) THE  STOR-
 AGE  REQUIREMENTS  OF  THE DRUG; (IV) THE AVAILABILITY OF THE INSURED TO
 RECEIVE THE PRESCRIPTION; OR (V) THE  INSURED'S  ABILITY  TO  COMPREHEND
 PHARMACEUTICAL  GUIDANCE AND SUPPORT OVER THE TELEPHONE, DETERMINES THAT
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD00064-02-9

 S. 6296                             2
 
 A DRUG AS PRESCRIBED ON AN INDIVIDUAL BASIS IS MOST APPROPRIATELY FILLED
 AT A RETAIL LOCATION, PROVIDED THAT AN IN-NETWORK RETAIL PHARMACY OF THE
 PATIENT'S CHOOSING AGREES TO THE SAME REIMBURSEMENT AMOUNT AND  IS  ABLE
 TO FILL THE PRESCRIPTION, THE PRESCRIBER'S DETERMINATION SHALL BE FINAL.
   §  3.  The opening paragraph of subsection (kk) of section 4303 of the
 insurance law is designated paragraph 1 and a new paragraph 2  is  added
 to read as follows:
   (2) NOTWITHSTANDING ANY OTHER PROVISION OF THIS SUBSECTION, IF A PRES-
 CRIBER,  AFTER CONSULTING WITH THE INSURER REGARDING THE APPROPRIATENESS
 OF MAIL ORDER DELIVERY GIVEN: (A) THE RESIDENCE OR DELIVERY LOCATION  OF
 THE COVERED PERSON; (B) THE MEDICAL CONDITION OF THE COVERED PERSON; (C)
 THE  STORAGE  REQUIREMENTS  OF  THE  DRUG;  (D)  THE AVAILABILITY OF THE
 COVERED PERSON TO RECEIVE THE PRESCRIPTION; OR (E) THE COVERED  PERSON'S
 ABILITY TO COMPREHEND PHARMACEUTICAL GUIDANCE AND SUPPORT OVER THE TELE-
 PHONE,  DETERMINES  THAT  A DRUG AS PRESCRIBED ON AN INDIVIDUAL BASIS IS
 MOST APPROPRIATELY FILLED AT A RETAIL LOCATION, PROVIDED THAT AN IN-NET-
 WORK RETAIL PHARMACY OF  THE  PATIENT'S  CHOOSING  AGREES  TO  THE  SAME
 REIMBURSEMENT   AMOUNT  AND  IS  ABLE  TO  FILL  THE  PRESCRIPTION,  THE
 PRESCRIBER'S DETERMINATION SHALL BE FINAL.
   § 4. This act shall take effect immediately.

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