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History
- Referred to insurance
- Referred to insurance
Full text
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Sponsor's memo
BILL NUMBER:A8863
Title of bill
An act to amend the insurance law, in relation to group health insurance policies and prescription drug coverage
Purpose or general idea of bill
Discourages the practice by health insurers of changing brand name drugs to generic drugs where the generic drugs are not the equivalent of the brand name.
Summary of specific provisions
Amends section 3221 of the insurance law by adding new subsections (r) and (s) providing that:
* Insurers shall not provide incentives to physicians based on the drugs they prescribe. * Insurers shall not require their policy holders to change to a drug that is not equivalent to their original prescribed medication. * Prescription co-pays shall not exceed the actual cost of the drug to the health plan. * In a system of tiered prescription co-pays, the maximum co-pay shall not exceeds 300% of the minimum co-pay. * Out-of-pocket expenses for prescription drugs shall be included in any applicable health plan cap on out-of-pocket medical expenses.
Justification
A growing number of health maintenance organizations are trying to reduce their costs and premiums by encouraging the use of generic medications by their members. Where a generic equivalent exists for drugs currently used by a member, such a strategy can reduce costs without a significant risk of adverse side effects. But where there is no generic equivalent, patient drug switches should only be pursued with the approval of that patient's prescribing physician. Insurer attempts to influence physician drug prescription behavior by offering physicians financial incentives to prescribe low cost medications should also be prohibited because it undermines the relationship between doctors and their patients and can lead to medically unnecessary prescription switches.
Legislative history
This is a new bill.
Fiscal implications
No costs to the state
Effective date
This act shall take effect immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.