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Who cares
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Sponsors
1 Co-sponsor
History
- Print number 695a
- Amend and recommit to insurance
- Referred to insurance
- Referred to insurance
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to coverage for single source drugs
Purpose or general idea of the bill
The purpose of this legislation is to require continued coverage of a prescription drug if a patient was on such drug prior to a policy change.
Summary of provisions
Section 1 of the bill amends the adds a new paragraph 33 to subsection(i) of § 3216 of the insurance law to require continued cover- age of a prescription drug if such drug was previously covered under an individual's insurance plan and no generic equivalent is available.
Read the full memo (645 words)
Section 2 of the bill adds a new paragraph 21 to subsection (k) of § 3221 of the insurance law requiring each group policy to continue cover- age of a prescription drug during a grievance or an appeal when a policy removes a prescription from the formulary while patient was taking such drug as part of a prescribed therapy.
Section 3 of the bill adds a new subsection (qq) to § 4303 of the insurance law requiring contracts issued by a health service corporation or a medical expense indemnity corporation to continue coverage of a prescription drug during a grievance or an appeal when a policy removes a prescription from the formulary while the patient was taking such drug as part of a prescribed therapy.
Section 4 sets forth an effective date of the first day of the calendar month next succeeding the sixtieth day after it shall have become a law but shall apply 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 similar 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 that 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 or, one drug may be more effective under certain conditions. In any event, health care cannot be directed by the bottom dollar in
every instance. When a patient's well being is affected, policy must be changed for the betterment of the patient.
Legislative history
2013-14, S.670/A.6130 (Ramos) 2011-12, S.7180/A.3718 (Rivera) (Enacting Clause Stricken) 2009-10, S.5510 (Klein)/A.4191 (Rivera) 2007-08, A.6739 (Rivera) 2005-06, S.4084 (Alesi)/A.3035 (Rivera) 2003-04, S.4904-A (Alesi)/A.6012-A (Rivera) 2001-02, S.6588-B (Alesi)/A.1912-C (Rivera) 1999-00, A.9448 (Colman)
Fiscal implications
None.
Effective date
This act shall take effect on the first day of the calendar month next succeeding the sixtieth day after it shall have become a law but shall apply only to policies and contracts issued, renewed or amended on or after the effective date of this act.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.