S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6492
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                               June 13, 2019
                                ___________
 
 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  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

 S. 6492                             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;

 S. 6492                             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
 ________________________________________________________________________
 
                                  6492--B
     Cal. No. 555
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                               June 13, 2019
                                ___________
 
 Introduced  by  Sens.  RIVERA,  CARLUCCI,  GOUNARDES, HARCKHAM, HOYLMAN,
   KAPLAN, KRUEGER,  MAYER,  METZGER,  MYRIE,  PERSAUD,  RAMOS,  SALAZAR,
   SEPULVEDA, SERRANO -- read twice and ordered printed, and when printed
   to  be  committed  to  the  Committee  on  Rules -- recommitted to the
   Committee on Health in accordance  with  Senate  Rule  6,  sec.  8  --
   committee  discharged,  bill amended, ordered reprinted as amended and
   recommitted to said committee -- reported favorably from said  commit-
   tee  and  committed  to the Committee on Finance -- 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 public health law, in relation  to  drug  assistance
   demonstration and emergency prescriptions
 
   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.  1.  THE  COMMISSIONER
 SHALL  DEVELOP A DEMONSTRATION PROGRAM (THE "PROGRAM") TO PROVIDE ACCESS
 TO INSULIN AND OTHER  LIFE  SUSTAINING  MAINTENANCE  PRESCRIPTION  DRUGS
 IDENTIFIED  BY THE COMMISSIONER FOR RESIDENTS OF THE STATE WHO ARE WITH-
 OUT HEALTH COVERAGE, ARE INELIGIBLE FOR MEDICAID OR OTHER PUBLICLY FUND-
 ED HEALTH COVERAGE, OR ARE OTHERWISE DETERMINED TO BE  ELIGIBLE  BY  THE
 COMMISSIONER  AND  DEPEND  UPON  SUCH  MEDICATION FOR THEIR SURVIVAL. IN
 DEVELOPING THE PROGRAM THE COMMISSIONER SHALL:
   (A) CONSIDER MODELING THE PROGRAM ON THE STATE'S HIV/AIDS DRUG ASSIST-
 ANCE PROGRAM PROVIDING ACCESS TO ELIGIBLE INDIVIDUALS AT CERTAIN  INCOME
 THRESHOLDS ABOVE THE FEDERAL POVERTY LEVEL; AND
   (B)  ENGAGE  WITH  PHARMACEUTICAL  MANUFACTURERS  TO  EXPLORE A PUBLIC
 PRIVATE PARTNERSHIP TO BRING AFFORDABLE DRUGS  THROUGH  THE  PROGRAM  TO
 ELIGIBLE INDIVIDUALS.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

                       [ ] is old law to be omitted.
                                                            LBD13323-13-0

 S. 6492--B                          2
 
   2. THE COMMISSIONER SHALL REPORT TO THE GOVERNOR, THE TEMPORARY PRESI-
 DENT  OF  THE SENATE, THE SPEAKER OF THE ASSEMBLY, AND THE CHAIRS OF THE
 SENATE AND ASSEMBLY HEALTH COMMITTEES ON THE AVAILABLE OPTIONS TO ESTAB-
 LISH THE PROGRAM, VARIOUS COST SHARING MODELS FOR ELIGIBLE  PARTICIPANTS
 AND  THE  RELATED  COSTS  TO  THE STATE ASSOCIATED WITH IMPLEMENTING THE
 PROGRAM. THE REPORT SHALL BE A PUBLIC DOCUMENT  POSTED  ON  THE  DEPART-
 MENT'S  WEBSITE.  THE  REPORT SHALL BE ISSUED NO LATER THAN THREE MONTHS
 AFTER THE EFFECTIVE DATE OF THIS SECTION.
   § 279-B. EMERGENCY PRESCRIPTIONS. 1. A HEALTH CARE PRACTITIONER WHO IS
 AUTHORIZED  TO  PRESCRIBE  A  DRUG  MAY  ISSUE  A   NON-PATIENT-SPECIFIC
 PRESCRIPTION  FOR  THE  DRUG  TO  A  PHARMACIST TO DISPENSE AN EMERGENCY
 REFILL FOR AN EXPIRED PRESCRIPTION FOR THE DRUG, UNDER  SUBDIVISION  TWO
 OF THIS SECTION.
   2.  A  PHARMACIST  MAY DISPENSE INSULIN AND RELATED SUPPLIES, OR OTHER
 LIFE SUSTAINING MAINTENANCE PRESCRIPTION DRUG IDENTIFIED BY THE  COMMIS-
 SIONER,  THROUGH  A  NON-PATIENT-SPECIFIC PRESCRIPTION, TO AN INDIVIDUAL
 WHO HAS HAD A VALID PRESCRIPTION FOR THE DRUG 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 PRESCRIBER OF
 THE PATIENT-SPECIFIC PRESCRIPTION AND CANNOT OBTAIN  THE  AUTHORIZATION,
 AND  THE  PRESCRIBER  DOES NOT OBJECT TO DISPENSING TO THE PATIENT UNDER
 THE NON-PATIENT-SPECIFIC PRESCRIPTION;
   (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  AND THE QUANTITY OF THAT
 REFILL IS IN CONFORMITY WITH THE DIRECTIONS FOR USE UNDER  THE  PATIENT-
 SPECIFIC  PRESCRIPTION, 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 ORIGINAL PRESCRIBER THAT AN EMERGENCY PRESCRIPTION HAS BEEN
 DISPENSED.
   § 2. This act shall take effect immediately.