A08533 Summary:

BILL NOA08533A
 
SAME ASSAME AS S06492-A
 
SPONSORJoyner
 
COSPNSRO'Donnell, Lentol, Williams, Reyes, Seawright, Simon, Hevesi, Fernandez, Dinowitz, Burke, Mosley, Dickens, Rosenthal L, Arroyo, Fall, Smith, McDonough, Montesano, Ortiz, Colton, Thiele, Jaffee, Gunther, Cruz, Cook, Magnarelli, Walker, Carroll, De La Rosa, Blake, Griffin, D'Urso, Bronson, DenDekker, Benedetto, Sayegh, Jacobson, Stirpe, Manktelow, Gottfried, Barron, Otis, Taylor, Simotas, Crespo, Rosenthal D, Niou, Glick, Woerner, Lavine, Abinanti, Miller MG, Aubry, Buttenschon
 
MLTSPNSRBuchwald, Tague
 
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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A08533 Actions:

BILL NOA08533A
 
08/14/2019referred to health
01/08/2020referred to health
02/10/2020amend and recommit to health
02/10/2020print number 8533a
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A08533 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A8533A
 
SPONSOR: Joyner
  TITLE OF BILL: 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   PURPOSE: To ensure that those in need of insulin can access it through various initiatives including a drug an assistance demonstration program, emer- gency refills for expired prescriptions and reasonable insurance cost sharing.   SUMMARY OF PROVISIONS: Section 1 amends Public Health Law to add a new section 279-a directing the Department of Health to develop a demonstration program to ensure access to insulin and other life sustaining, maintenance prescription medications for patient who meet certain medical criteria, are uninsured or underinsured and are ineligible for Medicaid or other publicly funded health coverage and meet certain financial criteria. The Department is directed to report to the Governor and Legislature on its findings no later than 60 days after enactment. This section also creates a new section 279-b to allow a health care provider to issue non-patient specific standing order for a pharmacist to dispense an emergency prescriptions to refills expired prescriptions for any types of insulin, or other medications identified by the commis- sioner, for an individual whose prescription has expired within the last twelve month and is unable to get authorization for a refill. Pharma- cists are allowed to dispense emergency refill of insulins, related supplies or other life sustaining, maintenance prescription medications identified by the commissioner under this section. Sections 2, 3, 4 and 5 of the bill amend sections 3216, 3221, 4303 of the insurance law and 4406c of the public health law to limit the total amount an insured individual must pay for a 30 day supply of any kind of insulin to $100 regardless of their insurance policies' co-payments or other cost sharing requirements,. Section 6 provides an effective date.   JUSTIFICATION: In recent years, there has been a dramatic rise in prices for insulin, a lifesaving prescription medication that many people with diabetes must take to regulate their glucose levels. According to the American Diabetes Association, about 7.4 million Americans rely on insulin and approximately 2 million of those are New York residents. The cost of the four most popular types of insulin have tripled over the last decade, and the out of pocket costs have doubled. These price hikes are report- edly not attributeable to increases in usage or new products that are more innovative. They not only affect those who are uninsured and unde- rinsured, they also affect those with health insurance who experience exorbitant. co-pays. The rising costs of insulin have dramatic effects on patients. Studies have shown that 1 in 4 patients use less insulin than prescribed in order to ration it. Rationing is very dangerous and can lead to deadly outcomes for those who depend on insulin. As a result of the skyrocketing insulin prices, congress initiated public hearings in 2019 to investigate what can be done nationally to control prices and several states are taking action to make sure patients who depend on insulin for their very survival can get it. Some consumers have report- edly begun travelling to Canada to secure more affordable insulin. States are also taking action. Colorado recently adopted legislation to cap insurance copays at $100 for a 30 day supply and several states including Pennsylvania have enacted laws to ensure that when a prescription for insulin has expired, a pharmacist has the ability to provide an emergency refill. This legislation adopts both of those measures but also directs the Department of Health to develop a Drug Assistance Demonstration Program to assist patients who do not have insurance, are not eligible for Medi- caid or other publicly funded health care coverage, or are deemed eligi- ble by the Commissioner, to be able to access life sustaining medica- tions such as insulin. It directs the Department to report to the Governor and the legislature on the options available to establish such a program and the resultant state costs to support such a program. New York has a long history of being ahead of the nation in providing health care assistance to its resident's. In the 1980's, in response to the AIDS epidemic, New York was one of the first states to create a program to provide AIDS/HIV medications to low-income patients. New York should look at this groundbreaking program as a model to ensure New Yorkers who depend on other life sustaining medications, like insulin, also have access to assistance, especially in light of the skyrocketing costs. This legislation provides a multi-pronged approach to addressing access to affordable insulin for patients in New York who rely upon it for their very existence.   LEGISLATIVE HISTORY: New bill.   FISCAL IMPLICATIONS: None.   EFFECTIVE DATE: : Immediately, provided sections 2, 3, 4 and 5 are effective January 1,2021.
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A08533 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         8533--A
 
                               2019-2020 Regular Sessions
 
                   IN ASSEMBLY
 
                                     August 14, 2019
                                       ___________
 
        Introduced  by  M.  of  A.  JOYNER,  O'DONNELL, LENTOL, WILLIAMS, REYES,
          SEAWRIGHT, SIMON, HEVESI, FERNANDEZ, DINOWITZ, BURKE, MOSLEY, DICKENS,
          L. ROSENTHAL,  ARROYO,  FALL,  SMITH,  McDONOUGH,  MONTESANO,   ORTIZ,
          COLTON,  THIELE,  JAFFEE,  GUNTHER,  CRUZ,  COOK,  MAGNARELLI, WALKER,
          CARROLL, DE LA ROSA, BLAKE, GRIFFIN, D'URSO, BRONSON, DenDEKKER, BENE-
          DETTO, SAYEGH, JACOBSON, STIRPE, MANKTELOW, GOTTFRIED,  BARRON,  OTIS,
          TAYLOR,  SIMOTAS  -- Multi-Sponsored by -- M. of A. BUCHWALD, TAGUE --
          read once and referred to the Committee on Health  --  recommitted  to
          the  Committee on Health in accordance with Assembly Rule 3, sec. 2 --
          committee discharged, bill amended, ordered reprinted as  amended  and
          recommitted to said committee
 
        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;
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD13323-09-0

        A. 8533--A                          2
 
     1    2. engage  with  pharmaceutical  manufacturers  to  explore  a  public
     2  private partnership designed to bring affordable medications through the
     3  demonstration program to eligible individuals; and
     4    3.  report to the governor, the temporary president of the senate, the
     5  speaker of the assembly, and the  chairs  of  the  senate  and  assembly
     6  health  committees  on the available options to establish a drug assist-
     7  ance demonstration program, various cost  sharing  models  for  eligible
     8  participants  and  the related costs to the state associated with imple-
     9  menting such a program no later than sixty days after the effective date
    10  of this section.
    11    § 279-b. Emergency prescriptions. 1. A health care practitioner who is
    12  authorized  to  prescribe  drugs   may   issue      non-patient-specific
    13  prescriptions  for  pharmacists to dispense   emergency prescriptions to
    14  refill  expired  prescriptions  pursuant  to  subdivision  two  of  this
    15  section.
    16    2.  A  pharmacist  may dispense insulin and related supplies, or other
    17  life sustaining, maintenance prescription medications identified by  the
    18  commissioner, through non-patient-specific prescriptions, to an individ-
    19  ual  who has had a valid prescription for any types of insulin, or other
    20  medications identified by the  commissioner,  during  the  prior  twelve
    21  month  period  which  have since expired, on an emergency basis provided
    22  the pharmacist:
    23    (a) first attempts to obtain  an  authorization  from  the  authorized
    24  prescriber and cannot obtain the authorization;
    25    (b)  believes,  that  in  the  pharmacist's professional judgment, the
    26  interruption of the therapy  reasonably  might  produce  an  undesirable
    27  health  consequence  detrimental to the patient's welfare or cause phys-
    28  ical or mental discomfort;
    29    (c) provides refill of the prescription or prescriptions and the quan-
    30  tity of that refill or refills is  in  conformity  with  the  prescribed
    31  directions  for use, but limited to an amount not to exceed a thirty-day
    32  emergency supply; and
    33    (d) notifies, within seventy-two hours of  dispensing  the  refill  or
    34  refills,  the prescriber that an emergency prescription or prescriptions
    35  have been dispensed.
    36    § 2. Subparagraph (B) of paragraph 15-a of subsection (i)  of  section
    37  3216  of  the insurance law, as added by chapter 378 of the laws of 1993
    38  and such paragraph as renumbered by chapter 338 of the laws of 2003,  is
    39  amended to read as follows:
    40    (B) Such coverage may be subject to annual deductibles and coinsurance
    41  as may be deemed appropriate by the superintendent and as are consistent
    42  with  those  established  for  other  benefits  within  a  given policy;
    43  provided however, the total amount that a covered person is required  to
    44  pay out of pocket for covered prescription insulin drugs shall be capped
    45  at  an  amount  not to exceed one hundred dollars per thirty-day supply,
    46  regardless of the amount or types of insulin needed to fill such covered
    47  person's prescriptions  and  regardless  of  the  insured's  deductible,
    48  copayment,  coinsurance, out of pocket maximum or any other cost sharing
    49  requirement.
    50    § 3. Subparagraph (B) of paragraph 7 of subsection (k) of section 3221
    51  of the insurance law, as amended by chapter 338 of the laws of 2003,  is
    52  amended to read as follows:
    53    (B) Such coverage may be subject to annual deductibles and coinsurance
    54  as may be deemed appropriate by the superintendent and as are consistent
    55  with  those  established  for  other  benefits  within  a  given policy;
    56  provided however, the total amount that a covered person is required  to

        A. 8533--A                          3
 
     1  pay out of pocket for covered prescription insulin drugs shall be capped
     2  at  an  amount  not to exceed one hundred dollars per thirty-day supply,
     3  regardless of the amount or types of insulin needed to fill such covered
     4  person's  prescriptions  and  regardless  of  the  insured's deductible,
     5  copayment, coinsurance, out of pocket maximum or any other cost  sharing
     6  requirement.
     7    §  4.  Paragraph  2 of subsection (u) of section 4303 of the insurance
     8  law, as amended by chapter 338 of the laws of 2003, is amended  to  read
     9  as follows:
    10    (2) Such coverage may be subject to annual deductibles and coinsurance
    11  as may be deemed appropriate by the superintendent and as are consistent
    12  with  those  established  for  other  benefits  within  a  given policy;
    13  provided however, the total amount that a covered person is required  to
    14  pay out of pocket for covered prescription insulin drugs shall be capped
    15  at  an  amount  not to exceed one hundred dollars per thirty-day supply,
    16  regardless of the amount or types of insulin needed to fill such covered
    17  person's prescriptions  and  regardless  of  the  insured's  deductible,
    18  copayment,  coinsurance, out of pocket maximum or any other cost sharing
    19  requirement.
    20    § 5. Subdivision 7 of section 4406-c of  the  public  health  law,  as
    21  added by chapter 536 of the laws of 2010, is amended to read as follows:
    22    7.  (i) No health maintenance organization which provides coverage for
    23  prescription drugs and for which cost-sharing, deductibles  or  co-insu-
    24  rance obligations are determined by category of prescription drugs shall
    25  impose  cost-sharing,  deductibles  or  co-insurance obligations for any
    26  prescription drug that exceeds the dollar amount of cost-sharing, deduc-
    27  tibles or co-insurance obligations for non-preferred brand drugs or  its
    28  equivalent (or brand drugs if there is no non-preferred brand drug cate-
    29  gory).
    30    (ii)  The total amount that a covered person is required to pay out of
    31  pocket for covered prescription insulin drugs  shall  be  capped  at  an
    32  amount  not to exceed one hundred dollars per thirty-day supply, regard-
    33  less of the amount or types of  insulin  needed  to  fill  such  covered
    34  person's  prescriptions  and  regardless  of  the  insured's deductible,
    35  copayment, coinsurance, out of pocket maximum or any other cost  sharing
    36  requirement.
    37    §  6.  This  act  shall take effect immediately; provided however that
    38  sections two, three, four and five of this act shall take effect January
    39  1, 2021.
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