Prohibits health insurers from requiring insureds purchase prescribed drugs from mail order pharmacy

1 Co-sponsor

• Betty Little

Title of bill

An act to amend the insurance law and the labor law, in relation to the purchase of prescription drugs

Purpose or general idea of bill

Prohibits health insurance policies from mandating their insured to purchase prescribed drugs from a mail order pharmacy.

Summary of specific provisions

Subsection (i) of Section 3216 of the insurance law is amended to preclude health insurance policies from mandating that their insured purchase prescribed drugs from mail order pharmacies. Such policies are also precluded from imposing a co-payment fee or other condition on an insured who chooses not to purchase from a designated mail order pharmacy.

A new paragraph 20 is also added to subsection (1) of Section 3221 of such law and a new Subsection (aa) is likewise added to section 4303 to impose such a prohibition on all policies of health insurance in the state including those issued by health services or medical expense indemnity corporations issuing group contracts.

Justification

This legislation will provide freedom of choice to consumers who have coverage for prescribed drugs as part of their health insurance. When a policy mandates purchase from a specific mail order pharmacy the consumer is forced to purchase an interim supply of the prescribed drug from his or her neighborhood pharmacist who is familiar with his or her medical history. The risk to the consumer in this situation is obvious.

Furthermore, the neighborhood pharmacy in these situations is forced to bear the burden of educating the patient as to the use and potential effects of the prescribed drug. The inability of the consumer to purchase the full prescription from the neighborhood pharmacy imposes this burden inequitably, thereby providing the mail order house with an economic advantage that the local provider cannot over-come.

Finally, many consumers, especially senior citizens, rely on their local pharmacist for the service that they provide with respect to monitoring the regimen of drugs that they take. A mandate of purchase by mail denies them of this important service and confidence.

Prior legislative history

A.2808/S.8775 (2007-2008) A.6934 (2005-2006)

Fiscal implications

None.

Effective date

This act shall take effect on the thirtieth day after it shall have become law and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such effective date.