S T A T E O F N E W Y O R K
________________________________________________________________________
7767
I N S E N A T E
January 11, 2022
___________
Introduced by Sen. BRESLIN -- 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 prescription drug
formulary changes during a plan year; to amend a chapter of the laws
of 2021 amending the insurance law and the public health law relating
to prescription drug formulary changes during a contract year, as
proposed in legislative bills numbers S. 4111 and A. 4668, in
relation to the effectiveness thereof; and to repeal section 4909 of
the insurance law and section 4909 of the public health law relating
thereto
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 4909 of the insurance law, as added by a chapter of
the laws of 2021 amending the insurance law and the public health law
relating to prescription drug formulary changes during a contract year,
as proposed in legislative bills numbers S. 4111 and A. 4668, is
REPEALED.
§ 2. Section 4909 of the public health law, as added by a chapter of
the laws of 2021 amending the insurance law and the public health law
relating to prescription drug formulary changes during a contract year,
as proposed in legislative bills numbers S. 4111 and A. 4668, is
REPEALED.
§ 3. Section 3242 of the insurance law is amended by adding a new
subsection (c) to read as follows:
(C)(1) EXCEPT AS OTHERWISE PROVIDED IN PARAGRAPH THREE OF THIS
SUBSECTION, AN INSURER 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, ISSU-
ANCE OR RENEWAL OF COVERAGE.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD08236-02-2
S. 7767 2
(2) PROHIBITIONS PROVIDED IN PARAGRAPH ONE OF THIS SUBSECTION SHALL
APPLY BEGINNING ON THE DATE ON WHICH A PLAN YEAR BEGINS AND THROUGH THE
END OF SUCH PLAN YEAR.
(3) (A) AN INSURER 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 COINSURANCE IF AN
AB-RATED GENERIC EQUIVALENT OR INTERCHANGEABLE BIOLOGICAL PRODUCT FOR
SUCH PRESCRIPTION DRUG IS ADDED TO THE FORMULARY AT THE SAME TIME.
(B) AN INSURER 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 ADMIN-
ISTRATION SAFETY CONCERNS.
(C) AN INSURER WITH A FORMULARY THAT INCLUDES TWO OR MORE TIERS OF
BENEFITS PROVIDING FOR DIFFERENT COPAYMENTS APPLICABLE TO PRESCRIPTION
DRUGS MAY MOVE A PRESCRIPTION DRUG TO A TIER WITH A LARGER COPAYMENT
DURING THE PLAN YEAR, PROVIDED THE CHANGE IS NOT APPLICABLE TO AN
INSURED WHO IS ALREADY RECEIVING SUCH PRESCRIPTION DRUG OR HAS BEEN
DIAGNOSED WITH OR PRESENTED WITH A CONDITION ON OR PRIOR TO THE START OF
THE PLAN YEAR THAT IS TREATED BY SUCH PRESCRIPTION DRUG OR IS A
PRESCRIPTION DRUG THAT IS OR WOULD BE PART OF THE INSURED'S TREATMENT
REGIMEN FOR SUCH CONDITION.
(4) AN INSURER SHALL PROVIDE NOTICE TO INSUREDS OF THE INTENT TO
REMOVE A PRESCRIPTION DRUG FROM A FORMULARY OR ALTER DEDUCTIBLE, COPAY-
MENT OR COINSURANCE REQUIREMENTS IN THE UPCOMING PLAN YEAR, NINETY DAYS
PRIOR TO THE START OF THE PLAN YEAR. SUCH NOTICE OF IMPENDING FORMULARY
AND DEDUCTIBLE, COPAYMENT OR COINSURANCE CHANGES SHALL ALSO BE POSTED ON
THE INSURER'S ONLINE FORMULARY AND IN ANY PRESCRIPTION DRUG FINDER
SYSTEM THAT THE INSURER PROVIDES TO THE PUBLIC.
(5) THE PROVISIONS OF THIS SUBSECTION SHALL NOT SUPERSEDE THE TERMS OF
A COLLECTIVE BARGAINING AGREEMENT, OR THE RIGHTS OF LABOR REPRESENTATION
GROUPS TO COLLECTIVELY BARGAIN CHANGES TO THE FORMULARIES.
§ 4. Section 4329 of the insurance law is amended by adding a new
subsection (c) to read as follows:
(C) (1) EXCEPT AS OTHERWISE PROVIDED IN PARAGRAPH THREE OF THIS
SUBSECTION, A CORPORATION 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, ISSU-
ANCE OR RENEWAL OF COVERAGE.
(2) PROHIBITIONS PROVIDED IN PARAGRAPH ONE OF THIS SUBSECTION SHALL
APPLY BEGINNING ON THE DATE ON WHICH A PLAN YEAR BEGINS AND THROUGH THE
END OF SUCH PLAN YEAR.
(3) (A) A CORPORATION WITH A FORMULARY THAT INCLUDES TWO OR MORE TIERS
OF BENEFITS PROVIDING FOR DIFFERENT DEDUCTIBLES, COPAYMENTS OR COINSU-
RANCE 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.
S. 7767 3
(B) A CORPORATION 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.
(C) A CORPORATION WITH A FORMULARY THAT INCLUDES TWO OR MORE TIERS OF
BENEFITS PROVIDING FOR DIFFERENT COPAYMENTS APPLICABLE TO PRESCRIPTION
DRUGS MAY MOVE A PRESCRIPTION DRUG TO A TIER WITH A LARGER COPAYMENT
DURING THE PLAN YEAR, PROVIDED THE CHANGE IS NOT APPLICABLE TO AN
INSURED WHO IS ALREADY RECEIVING SUCH PRESCRIPTION DRUG OR HAS BEEN
DIAGNOSED WITH OR PRESENTED WITH A CONDITION ON OR PRIOR TO THE START OF
THE PLAN YEAR THAT IS TREATED BY SUCH PRESCRIPTION DRUG OR IS A
PRESCRIPTION DRUG THAT IS OR WOULD BE PART OF THE INSURED'S TREATMENT
REGIMEN FOR SUCH CONDITION.
(4) A CORPORATION SHALL PROVIDE NOTICE TO INSUREDS OF THE INTENT TO
REMOVE A PRESCRIPTION DRUG FROM A FORMULARY OR ALTER DEDUCTIBLE, COPAY-
MENT OR COINSURANCE REQUIREMENTS IN THE UPCOMING PLAN YEAR, NINETY DAYS
PRIOR TO THE START OF THE PLAN YEAR. SUCH NOTICE OF IMPENDING FORMULARY
AND DEDUCTIBLE, COPAYMENT OR COINSURANCE CHANGES SHALL ALSO BE POSTED ON
THE CORPORATION'S ONLINE FORMULARY AND IN ANY PRESCRIPTION DRUG FINDER
SYSTEM THAT THE CORPORATION PROVIDES TO THE PUBLIC.
(5) THE PROVISIONS OF THIS SUBSECTION SHALL NOT SUPERSEDE THE TERMS OF
A COLLECTIVE BARGAINING AGREEMENT, OR THE RIGHTS OF LABOR REPRESENTATION
GROUPS TO COLLECTIVELY BARGAIN CHANGES TO THE FORMULARIES.
§ 5. Section 3 of a chapter of the laws of 2021 amending the insurance
law and the public health law relating to prescription drug formulary
changes during a contract year, as proposed in legislative bills numbers
S. 4111 and A. 4668, is amended to read as follows:
§ 3. This act shall take effect on [the sixtieth day after it shall
have become a law] JANUARY 1, 2023 AND SHALL APPLY TO ALL POLICIES AND
CONTRACTS ISSUED, RENEWED, MODIFIED, ALTERED OR AMENDED ON OR AFTER SUCH
DATE. Effective immediately, the addition, amendment and/or repeal of
any rule or regulation necessary for the [implantation] IMPLEMENTATION
of this act on its effective date are authorized to be made on or before
such effective date.
§ 6. This act shall take effect immediately; provided, however, that
sections one, two, three and four of this act shall take effect on the
same date and in the same manner as a chapter of the laws of 2021 amend-
ing the insurance law and the public health law relating to prescription
drug formulary changes during a contract year, as proposed in legisla-
tive bills numbers S. 4111 and A. 4668, takes effect.