Creates the state pharmaceutical local choice program

Section 1. Creates a new Title 4, Miscellaneous Provisions in the Elder Law, with a new section 300, Pharmaceutical Local Choice Program. Section 300, the Pharmaceutical Local Choice Program, requires that:

1. A health insurance policy which provides coverage for prescribed drugs that includes an option or a requirement that insureds purchase prescription drugs from a mail order pharmacy (i.e., a non-resident establishment, as defined in section 6808-b of the education law), shall additionally provide that an insured may purchase such drugs from a community pharmacy (i.e., one registered with the education department pursuant to section 6808 of the education law) which, insofar as reasonable, shall be located and accessible in the local community of the insured.

The subdivision defines the term "health insurance policy" to mean and include any policy of accident and health insurance delivered or issued for delivery in this state, and any group or blanket policy delivered or issued for delivery in this state, as described in appropriate sections of the insurance law.

2. This subdivision creates the consumer pharmaceutical insurance coverage panel, whose membership is the same as the EPIC panel, and whose purpose is to oversee the program for providing consumer choice in purchase of prescription pharmaceuticals within their own communities. The panel, and each member is authorized to and shall promulgate regulations to effect the purposes of this section, including requiring adherence to the provisions of this section by health insurance policies, and appropriate notification of insureds of the option to purchase prescription drugs at a pharmacy rather than a non-resident establishments; and to develop and implement, in cooperation with area offices for the aging or other units of local government and not for profit organizations, an outreach program to inform the elderly and others of the option to purchase prescription drugs at a pharmacy rather than a non-resident establishment.

3. This subdivision requires an annual report submitted to the governor and the legislature by January 1 of each year concerning the effect of any disparity in copayments or other fees or charges to consumers for purchase of the same or similar drugs through local pharmacies and mail order, by or pursuant to health insurance policies, including those provided under Medicare Part D. The report is to include annual statistical information derived by data collection by the panel, or from sampling, regarding the number of persons and plans affected, the amount of any such disparities, the required use of such non-resident establishments and pharmacies, and any recommendations by the panel concerning the need to prohibit or ameliorate such disparities. 4. This subdivision requires a l2-member advisory committee to the panel, with four members appointed by the governor, three by the temporary president of the senate, one by the minority leader of the senate, three members by the speaker of the assembly, and one member by the minority leader of the assembly. The advisory committee members shall be representatives of consumers and pharmacists, with no less than 50% representing consumers (including three representatives of statewide organizations representing the elderly and consumers), and two representatives of statewide organizations representing pharmacies.

Justification

There has been an explosion in the number of health insurance plans requiring mail order purchase of pharmaceuticals. This may make some sense on a cost basis, the insureds lose access to community pharmacies, with the protections afforded them. This bill simply tracks the requirements of the Medicare Part D plan, which allows mail-order, but also requires community pharmacy participation. In order to determine the possible effect of disparate fees, the bill also requires a study by the consumer pharmaceutical insurance coverage panel by January 1 of each year. The data from the study will give the legislature necessary information to determine whether steps need to be taken in this area also.

Legislative history

S.7506 of 2006 Aging, Rules; S.1776 - Rules

Fiscal implications

To be determined.

Effective date

July 1, 2009.