S T A T E O F N E W Y O R K
________________________________________________________________________
7499--B
Cal. No. 1338
2021-2022 Regular Sessions
I N S E N A T E
November 3, 2021
___________
Introduced by Sens. SALAZAR, MAY -- 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, ordered to first and second report, amended on second report,
ordered to a third reading, and to be reprinted as amended, retaining
its place in the order of third reading
AN ACT to amend the insurance law, in relation to requiring certain
manufacturers of prescription drugs to notify the superintendant of
any proposed increase of the wholesale acquisition cost of such
prescription drugs
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 111-a
to read as follows:
§ 111-A. NOTIFICATION OF PRESCRIPTION DRUG PRICE INCREASES BY MANUFAC-
TURERS. (A) THIS SECTION SHALL APPLY TO A MANUFACTURER OF A PRESCRIPTION
DRUG THAT IS PURCHASED OR REIMBURSED IN THIS STATE BY ANY OF THE FOLLOW-
ING:
(1) AN INSURANCE COMPANY AUTHORIZED IN THIS STATE TO WRITE ACCIDENT
AND HEALTH INSURANCE, A COMPANY ORGANIZED PURSUANT TO ARTICLE FORTY-
THREE OF THIS CHAPTER, A MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN
ESTABLISHED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER, AN ORGAN-
IZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
LAW, AN INSTITUTION OF HIGHER EDUCATION CERTIFIED PURSUANT TO SECTION
ONE THOUSAND ONE HUNDRED TWENTY-FOUR OF THIS CHAPTER, OR THE NEW YORK
STATE HEALTH INSURANCE PLAN ESTABLISHED PURSUANT TO ARTICLE ELEVEN OF
THE CIVIL SERVICE LAW; OR
(2) A PHARMACY BENEFIT MANAGER, INCLUDING AN ENTITY THAT DIRECTLY OR
THROUGH AN INTERMEDIARY, MANAGES THE PRESCRIPTION DRUG COVERAGE PROVIDED
BY A HEALTH INSURER UNDER A CONTRACT OR POLICY DELIVERED OR ISSUED FOR
DELIVERY IN THIS STATE OR A HEALTH PLAN SUBJECT TO SECTION THREE HUNDRED
SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW, INCLUDING THE PROCESSING AND
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05130-04-2
S. 7499--B 2
PAYMENT OF CLAIMS FOR PRESCRIPTION DRUGS, THE PERFORMANCE OF DRUG UTILI-
ZATION REVIEW, THE PROCESSING OF DRUG PRIOR AUTHORIZATION REQUESTS, THE
ADJUDICATION OF APPEALS OR GRIEVANCES RELATED TO PRESCRIPTION DRUG
COVERAGE, CONTRACTING WITH NETWORK PHARMACIES, AND CONTROLLING THE COST
OF COVERED PRESCRIPTION DRUGS.
(B) (1) A MANUFACTURER OF A PRESCRIPTION DRUG WITH A WHOLESALE ACQUI-
SITION COST OF MORE THAN FORTY DOLLARS FOR A COURSE OF THERAPY SHALL
NOTIFY THE SUPERINTENDENT, HIS OR HER DEPUTY OR OTHER OFFICER DESIGNATED
BY THE SUPERINTENDENT, IF THE INCREASE IN THE WHOLESALE ACQUISITION COST
OF SUCH PRESCRIPTION DRUG IS MORE THAN TEN PERCENT, INCLUDING THE
PROPOSED INCREASE AND THE CUMULATIVE INCREASES THAT OCCURRED WITHIN THE
PREVIOUS TWENTY-FOUR MONTHS. FOR PURPOSES OF THIS SECTION, A "COURSE OF
THERAPY" IS DEFINED AS EITHER OF THE FOLLOWING:
(I) THE RECOMMENDED DAILY DOSAGE UNITS OF A PRESCRIPTION DRUG PURSUANT
TO ITS PRESCRIBING LABEL AS APPROVED BY THE FEDERAL FOOD AND DRUG ADMIN-
ISTRATION FOR THIRTY DAYS; OR
(II) THE RECOMMENDED DAILY DOSAGE UNITS OF A PRESCRIPTION DRUG PURSU-
ANT TO ITS PRESCRIBING LABEL AS APPROVED BY THE FEDERAL FOOD AND DRUG
ADMINISTRATION FOR A NORMAL COURSE OF TREATMENT THAT IS LESS THAN THIRTY
DAYS.
(2) (I) THE NOTICE REQUIRED BY PARAGRAPH (1) OF THIS SUBSECTION SHALL
BE PROVIDED IN WRITING TO THE SUPERINTENDENT AT LEAST SIXTY DAYS PRIOR
TO THE PLANNED EFFECTIVE DATE OF THE INCREASE AND SHALL INCLUDE THE
PROPOSED INCREASE AND THE CUMULATIVE INCREASES THAT OCCURRED WITHIN THE
PREVIOUS TWENTY-FOUR MONTHS.
(II) THE SUPERINTENDENT SHALL FORTHWITH PUBLISH THE NOTICE REQUIRED BY
PARAGRAPH (A) OF THIS SUBDIVISION ON THE DEPARTMENT OF FINANCIAL
SERVICES WEBSITE WITHIN FIVE DAYS OF ITS RECEIPT.
(3) (I) THE NOTICE REQUIRED BY PARAGRAPH (1) OF THIS SUBSECTION SHALL
INCLUDE THE DATE OF THE INCREASE, THE CURRENT WHOLESALE ACQUISITION COST
OF THE PRESCRIPTION DRUG, AND THE DOLLAR AMOUNT OF THE FUTURE INCREASE
IN THE WHOLESALE ACQUISITION COST OF THE PRESCRIPTION DRUG.
(II) THE NOTICE REQUIRED BY PARAGRAPH (1) OF THIS SUBSECTION SHALL
INCLUDE A STATEMENT REGARDING WHETHER A CHANGE OR IMPROVEMENT IN THE
DRUG NECESSITATES THE PRICE INCREASE. IF SO, THE MANUFACTURER SHALL
DESCRIBE THE CHANGE OR IMPROVEMENT.
(4) INFORMATION SUPPLIED BY A MANUFACTURER PURSUANT TO THIS SECTION
THAT THE MANUFACTURER HAS DESIGNATED AS A TRADE SECRET SHALL BE CONSID-
ERED CONFIDENTIAL AND A TRADE SECRET AND SHALL NOT BE DISCLOSED DIRECTLY
OR INDIRECTLY BY THE SUPERINTENDENT. NOTWITHSTANDING THE FOREGOING
SENTENCE, THE SUPERINTENDENT SHALL BE PERMITTED TO DISCLOSE INFORMATION
IN AN AGGREGATED FORMAT IF SUCH AGGREGATE INFORMATION CANNOT DIRECTLY OR
INDIRECTLY BE USED TO IDENTIFY TRADE SECRET INFORMATION RELATED TO A
SPECIFIC MANUFACTURER OR THE MANUFACTURER'S PRESCRIPTION DRUG, INCLUDING
BUT NOT LIMITED TO ANY INFORMATION RELATED TO PRICING FOR THE MANUFAC-
TURER'S PRESCRIPTION DRUG THAT HAS BEEN DESIGNATED AS A TRADE SECRET.
(5) IN THE EVENT THAT A MANUFACTURER OF A PRESCRIPTION DRUG SUBJECT TO
THIS SECTION DOES NOT REPORT THE INFORMATION REQUIRED IN PARAGRAPH (1)
OF THIS SUBSECTION, THE SUPERINTENDENT IS AUTHORIZED TO IMPOSE ANY
PENALTY OR REMEDY AUTHORIZED BY THIS CHAPTER, AFTER NOTICE AND A HEAR-
ING, AGAINST SUCH MANUFACTURER OF UP TO FIVE THOUSAND DOLLARS PER DAY
FOR EVERY DAY AFTER THE REPORTING PERIOD DESCRIBED IN THIS SECTION THAT
THE REQUIRED INFORMATION IS NOT REPORTED.
§ 2. This act shall take effect immediately.
