Provides that prescriptions covered by insurance, that would otherwise be required to be filled by mail order, may be filled at a retail pharmacy under certain circumstances

2 Co-sponsors

• Martin J. Golden
• Todd Kaminsky

Title of bill

An act to amend the insurance law, in relation to coverage of prescriptions obtained by mail order or at a non-retail pharmacy

Purpose

Ensure patient access to retail pharmacies upon the prescribers determination that mail order delivery would not be appropriate

Summary of provisions

Sections one, two and three amend Insurance Law §§ 3216, 3221 and 4303 respectively to provide that a prescriber, after consultation with the patient's insurer, may determine that mail order delivery of prescription medication is not appropriate given the patient's residence, medical condition, storage requirements of the drug, availability of the insured to receive the prescription or the patient's ability to understand guidance and support over the telephone. Provided a network pharmacy chosen by the patient agrees to the same reimbursement amount and is able to fill the prescription, the prescribers determination shall be final.

Section four provides that the act take effect immediately.

Justification

While recognizing the value of mail order pharmacies and the convenience they provide for many, not all patients have the same needs. For many patients, especially those with complex medical conditions, access to local pharmacies for their medications can be essential for their health and wellbeing. Patients may have residences lacking secure deliver locations, be on specific treatment regimens that may be disrupted if the medications are not promptly received, take medications that need special handling, or need the in person counseling of a pharmacists. There are many different reasons why an individual may benefit from access to a retail pharmacy rather than a mail order pharmacy. That decision should be made between the patient and his or her prescriber. The Legislature has already acknowledged the need to ensure patient access to pharmacy options. This legislation will expand upon the 2011 provisions to ensure a prescriber, considering all factors relevant to the patient, can determine when mail order is not appropriate. The bill also ensures that cost is not affected, by requiring the retail pharmacy to agree to the same reimbursement amount.

Legislative history

New bill.

Fiscal implications

None.

Effective date

Immediately.