NY State Senate Bill 2021-S5901

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 05, 2022	referred to insurance
Mar 22, 2021	referred to insurance

2021-S5901 (ACTIVE) - Details

See Assembly Version of this Bill:: A5032
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: A4131
2011-2012: A4724
2013-2014: A6130
2015-2016: A4477
2017-2018: A5273
2019-2020: S8105, A4899
2023-2024: S7344, A4494

2021-S5901 (ACTIVE) - Summary

Provides that every insurance policy which provides coverage for prescription drugs shall insure that there is continuous coverage of a single source drug that is part of a prescribed therapy until such prescribed therapy is no longer medically necessary for the enrollee of such policy; defines "single source drug".

2021-S5901 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S5901

SPONSOR: PARKER
 
TITLE OF BILL:

An act to amend the insurance law, in relation to coverage for single
source drugs

 
PURPOSE OR GENERAL IDEA OF BILL:

Requires continued coverage of a prescription drug if a patient was on
such drug prior to a policy change.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section one adds a new paragraph 35 to subsection (I) of § 3216 of the
insurance law to require continued coverage of a prescription drug if
such drug was previously covered under an individual's insurance plan
and no generic equivalent is available.

Section two adds anew paragraph 22 to subsection (k) of § 3221 of the

insurance law requiring each group policy to continue coverage of a
prescription drug during a grievance or an appeal when a policy removes
a prescription from the formulary while patient was taking such drug as
part of a prescribed therapy.

Section three adds a new subsection 55 to § 4303 of the insurance law
requiring contracts issued by a health service corporation or a medical
expense indemnity corporation to continue coverage of a prescription
drug during a grievance or an appeal when a policy removes a
prescription from the formulary while the patient was taking such drug
as part of a prescribed therapy.

Section four contains the effective date.

 
JUSTIFICATION:

This legislation was modeled after a 1998 law in California. This bill
would require an insurance plan to continue their coverage of
prescription medication for patients currently taking the medication
when no generic equivalent is available. When a patient is on a
prescribed therapy it is very important for the patient to maintain that
therapy to the end. When a drug is dropped from a plan, the consequences
can be dire and/or costly for the patients that are in various stages of
therapy with that drug. If the patient were to maintain the prescribed
therapy, the out of pocket cost to the patient could be so exorbitant
that the patient would eventually stop taking the prescription prior to
the completion of the therapy.

In another circumstance, the patient may be forced to change to a simi-
lar brand name drug - that is covered under the plan- in the midst of
the prescribed therapy. That new drug may not be as suitable or may
cause adverse reactions. The new drug may not react well with other
medication that the patient is taking. Also, the new drug may not
achieve the desired effect that the other drug accomplished. The physi-
cian should have the final say in which prescription a patient takes.
Although one drug may seem to have the same effect as another, it may
not be as compatible with other medications a patient is taking or, one
drug may be more effective under certain conditions.  In any event,
health care cannot be directed by the bottom dollar in every instance.
When a patient's wellbeing is affected, policy must be changed for the
betterment of the patient.

 
LEGISLATIVE HISTORY:

2019-20: S8105- Referred to Insurance

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect on the first day of the calendar month next
succeeding the sixtieth day after it shall have become a law but shall
apply only to policies and contracts issued, renewed or amended on or
after the effective date of this act.

2021-S5901 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5901
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                              March 22, 2021
                                ___________
 
 Introduced  by  Sen.  PARKER -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 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
 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD07901-01-1

 S. 5901                             2
 
 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.

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Senate Bill S5901

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

2021-S5901 (ACTIVE) - Details

2021-S5901 (ACTIVE) - Summary

2021-S5901 (ACTIVE) - Sponsor Memo

2021-S5901 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S5901

Share this bill

Sponsored By

Kevin S. Parker

Archive: Last Bill Status - In Senate Committee Insurance Committee

2021-S5901 (ACTIVE) - Details

2021-S5901 (ACTIVE) - Summary

2021-S5901 (ACTIVE) - Sponsor Memo

2021-S5901 (ACTIVE) - Bill Text download pdf

Comments