Requires health insurance policies covering prescription drugs to provide continuous coverage for single source drugs until the prescribed therapy therefor is not required

1 Co-sponsor

• Kevin S. Parker

Title of bill

An act to amend the insurance law, in relation to coverage for single source drugs

Purpose or general idea of bill

This bill requires continued coverage of a prescription drug if a patient was on such drug prior to a policy change.

Summary of provisions

Section 1: amends section 3216(i) by adding a new paragraph 25 which provides that every individual policy which has coverage for prescription drugs shall ensure that there is continuous coverage of a single source drug that is part of a prescribed therapy until the therapy is no longer medically necessary.

Section 2: amends section 3221(k) of the insurance law by adding a new paragraph 13 providing that every group policy which provides prescription drug coverage ensures that there is continuous coverage of a single source drug that is part of a prescribed therapy until the prescribed therapy is no longer medically necessary.

Section 3: amends section 4303 of the insurance law by adding a new subsection (bb). This section provides that every contract issued by a health service corporation or a medical expense indemnity corporation which provides prescription drug coverage shall ensure continuous coverage for single source drugs where the drug is part of a prescribed therapy which is medically necessary.

Section 4: 60 days after it shall become law, but applied only to policies and contracts issued, renewed or amended on or after the effective date of this act.

Justification

This legislation was modeled after a 1998 law in California. This bill would require an insurance plan to continue their coverage of prescription medication for patients currently taking the medication when no generic equivalent is available. When a patient is on a prescribed therapy it is very important for the patient to maintain that therapy to the end. When a drug is dropped from a plan, the consequences can be dire and/or costly for the patients that are in various stages of therapy with that drug. If the patient were to maintain the prescribed therapy, the out of pocket cost to the patient could be so exorbitant that the patient would eventually stop taking the prescription prior to the completion of the therapy.

In another circumstance, the patient may be forced to change to a simi- lar brand name drug that is covered under the plan in the midst of the prescribed therapy. That new drug may not be as suitable or may cause adverse reactions. The new drug may not react well with other medication the patient is taking. Also, the new drug may not achieve the desired effect that the other drug accomplished.

The physician should have the final say in which prescription a patient takes. Although one drug may seem to have the same effect as another it may not be as compatible with other medications a patient is taking. One drug may be more effective under certain conditions. In any event, health care cannot be directed by the bottom dollar in every instance.

Fiscal implications

To be determined.

Effective date

This act shall take effect 60 days after it shall become law, but shall apply to policies and contracts issued, renewed or amended on or after the effective date of this act.