S06492 Summary:

BILL NOS06492A
 
SAME ASSAME AS A08533-A
 
SPONSORRIVERA
 
COSPNSRCARLUCCI, GOUNARDES, HARCKHAM, HOYLMAN, KAPLAN, MAYER, METZGER, RAMOS, SALAZAR, SERRANO
 
MLTSPNSR
 
Add 279-a & 279-b, Pub Health L; amd 3216, 3221, 4303 & 4406-c, Ins L
 
Relates to a drug assistance demonstration program, emergency prescriptions and capping cost sharing for insulin.
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S06492 Actions:

BILL NOS06492A
 
06/13/2019REFERRED TO RULES
06/18/2019ORDERED TO THIRD READING CAL.1642
06/18/2019PASSED SENATE
06/18/2019DELIVERED TO ASSEMBLY
06/19/2019referred to health
01/08/2020died in assembly
01/08/2020returned to senate
01/08/2020REFERRED TO HEALTH
01/14/2020AMEND AND RECOMMIT TO HEALTH
01/14/2020PRINT NUMBER 6492A
01/28/2020REPORTED AND COMMITTED TO FINANCE
03/03/20201ST REPORT CAL.555
03/04/20202ND REPORT CAL.
03/10/2020ADVANCED TO THIRD READING
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S06492 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         6492--A
 
                               2019-2020 Regular Sessions
 
                    IN SENATE
 
                                      June 13, 2019
                                       ___________
 
        Introduced by Sens. RIVERA, CARLUCCI, HOYLMAN, KAPLAN, MAYER, METZGER --
          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  commit-
          tee
 
        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:
 
     1    Section 1. The public health law is amended by adding two new sections
     2  279-a and 279-b to read as follows:
     3    § 279-a. Drug assistance demonstration program. The commissioner shall
     4  develop a demonstration program to ensure access to  insulin  and  other
     5  life  sustaining, maintenance prescription medications identified by the
     6  commissioner for residents of the state who are uninsured, are  ineligi-
     7  ble for Medicaid or other publicly funded health coverage, or are other-
     8  wise  determined to be eligible by the commissioner and depend upon such
     9  medication for their survival. In developing such  program  the  commis-
    10  sioner shall:
    11    1.  consider modeling the drug assistance demonstration program on the
    12  state's HIV/AIDS drug assistance program providing  access  to  eligible
    13  individuals  at  certain  income  thresholds  above  the federal poverty
    14  level;
    15    2. engage  with  pharmaceutical  manufacturers  to  explore  a  public
    16  private partnership designed to bring affordable medications through the
    17  demonstration program to eligible individuals; and
    18    3.  report to the governor, the temporary president of the senate, the
    19  speaker of the assembly, and the  chairs  of  the  senate  and  assembly
    20  health  committees  on the available options to establish a drug assist-
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD13323-08-0

        S. 6492--A                          2
 
     1  ance demonstration program, various cost  sharing  models  for  eligible
     2  participants  and  the related costs to the state associated with imple-
     3  menting such a program no later than sixty days after the effective date
     4  of this section.
     5    § 279-b. Emergency prescriptions. 1. A health care practitioner who is
     6  authorized   to   prescribe   drugs  may  issue     non-patient-specific
     7  prescriptions for pharmacists to dispense   emergency  prescriptions  to
     8  refill  expired  prescriptions  pursuant  to  subdivision  two  of  this
     9  section.
    10    2. A pharmacist may dispense insulin and related  supplies,  or  other
    11  life  sustaining, maintenance prescription medications identified by the
    12  commissioner, through non-patient-specific prescriptions, to an individ-
    13  ual who has had a valid prescription for any types of insulin, or  other
    14  medications  identified  by  the  commissioner,  during the prior twelve
    15  month period which have since expired, on an  emergency  basis  provided
    16  the pharmacist:
    17    (a)  first  attempts  to  obtain  an authorization from the authorized
    18  prescriber and cannot obtain the authorization;
    19    (b) believes, that in  the  pharmacist's  professional  judgment,  the
    20  interruption  of  the  therapy  reasonably  might produce an undesirable
    21  health consequence detrimental to the patient's welfare or  cause  phys-
    22  ical or mental discomfort;
    23    (c) provides refill of the prescription or prescriptions and the quan-
    24  tity  of  that  refill  or  refills is in conformity with the prescribed
    25  directions for use, but limited to an amount not to exceed a  thirty-day
    26  emergency supply; and
    27    (d)  notifies,  within  seventy-two  hours of dispensing the refill or
    28  refills, the prescriber that an emergency prescription or  prescriptions
    29  have been dispensed.
    30    §  2.  Subparagraph (B) of paragraph 15-a of subsection (i) of section
    31  3216 of the insurance law, as added by chapter 378 of the laws  of  1993
    32  and  such paragraph as renumbered by chapter 338 of the laws of 2003, is
    33  amended to read as follows:
    34    (B) Such coverage may be subject to annual deductibles and coinsurance
    35  as may be deemed appropriate by the superintendent and as are consistent
    36  with those  established  for  other  benefits  within  a  given  policy;
    37  provided  however, the total amount that a covered person is required to
    38  pay out of pocket for covered prescription insulin drugs shall be capped
    39  at an amount not to exceed one hundred dollars  per  thirty-day  supply,
    40  regardless of the amount or types of insulin needed to fill such covered
    41  person's  prescriptions  and  regardless  of  the  insured's deductible,
    42  copayment, coinsurance, out of pocket maximum or any other cost  sharing
    43  requirement.
    44    § 3. Subparagraph (B) of paragraph 7 of subsection (k) of section 3221
    45  of  the insurance law, as amended by chapter 338 of the laws of 2003, is
    46  amended to read as follows:
    47    (B) Such coverage may be subject to annual deductibles and coinsurance
    48  as may be deemed appropriate by the superintendent and as are consistent
    49  with those  established  for  other  benefits  within  a  given  policy;
    50  provided  however, the total amount that a covered person is required to
    51  pay out of pocket for covered prescription insulin drugs shall be capped
    52  at an amount not to exceed one hundred dollars  per  thirty-day  supply,
    53  regardless of the amount or types of insulin needed to fill such covered
    54  person's  prescriptions  and  regardless  of  the  insured's deductible,
    55  copayment, coinsurance, out of pocket maximum or any other cost  sharing
    56  requirement.

        S. 6492--A                          3
 
     1    §  4.  Paragraph  2 of subsection (u) of section 4303 of the insurance
     2  law, as amended by chapter 338 of the laws of 2003, is amended  to  read
     3  as follows:
     4    (2) Such coverage may be subject to annual deductibles and coinsurance
     5  as may be deemed appropriate by the superintendent and as are consistent
     6  with  those  established  for  other  benefits  within  a  given policy;
     7  provided however, the total amount that a covered person is required  to
     8  pay out of pocket for covered prescription insulin drugs shall be capped
     9  at  an  amount  not to exceed one hundred dollars per thirty-day supply,
    10  regardless of the amount or types of insulin needed to fill such covered
    11  person's prescriptions  and  regardless  of  the  insured's  deductible,
    12  copayment,  coinsurance, out of pocket maximum or any other cost sharing
    13  requirement.
    14    § 5. Subdivision 7 of section 4406-c of  the  public  health  law,  as
    15  added by chapter 536 of the laws of 2010, is amended to read as follows:
    16    7.  (i) No health maintenance organization which provides coverage for
    17  prescription drugs and for which cost-sharing, deductibles  or  co-insu-
    18  rance obligations are determined by category of prescription drugs shall
    19  impose  cost-sharing,  deductibles  or  co-insurance obligations for any
    20  prescription drug that exceeds the dollar amount of cost-sharing, deduc-
    21  tibles or co-insurance obligations for non-preferred brand drugs or  its
    22  equivalent (or brand drugs if there is no non-preferred brand drug cate-
    23  gory).
    24    (ii)  The total amount that a covered person is required to pay out of
    25  pocket for covered prescription insulin drugs  shall  be  capped  at  an
    26  amount  not to exceed one hundred dollars per thirty-day supply, regard-
    27  less of the amount or types of  insulin  needed  to  fill  such  covered
    28  person's  prescriptions  and  regardless  of  the  insured's deductible,
    29  copayment, coinsurance, out of pocket maximum or any other cost  sharing
    30  requirement.
    31    §  6.  This  act  shall take effect immediately; provided however that
    32  sections two, three, four and five of this act shall take effect January
    33  1, 2021.
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