What's happening
This bill requires insurance plans to reimburse all network pharmacies, including local retail ones, equally for prescription drugs, regardless of mail order status.
Why it matters
Levels the playing field for local pharmacies. By mandating equal reimbursement for all in-network pharmacies, including small, independent, and retail locations, the bill could help sustain local businesses that often struggle to compete with large mail order operations.
Potentially increases patient choice and convenience. Patients would have more flexibility to fill prescriptions at their preferred pharmacy without financial penalty, which may improve medication adherence and allow for more personalized, face-to-face counseling from pharmacists.
Could impact insurance and pharmacy benefit manager (PBM) business practices. Insurers and PBMs that previously negotiated lower reimbursement rates with certain pharmacies (typically mail order) may face higher costs or need to renegotiate contracts, potentially affecting drug pricing structures and overall pharmacy networks.
May influence drug pricing and out-of-pocket costs. With uniform reimbursement rates, there could be downstream effects on premiums, copays, or medication costs, as insurers adjust to the new requirements—potentially benefiting some consumers while raising costs for others.
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Who cares
Network retail pharmacies
The bill would remove requirements to agree in advance through a network contract to mail-order pharmacies’ reimbursement terms and to accept the same nonpayment terms and conditions.
Health insurers and health services corporations
The bill would require the same reimbursement benchmarks, including average wholesale price, maximum allowable cost and national prescription drug codes, for participating mail-order and non-mail-order pharmacies.
Patients with prescription drug coverage
The bill would ease the conditions under which they could choose a participating retail pharmacy for prescriptions available through a network mail-order pharmacy, while retaining protections against additional copayments or conditions.
Headline styles
Let Pharmacies Match Drug Prices
Plain English, a few words. Used as the page title.
Sponsors
40 Co-sponsors
- Jeffrion Aubry
- Michael Blake
- David Buchwald
- Michael Cusick
- Steven Cymbrowitz
- Jeffrey Dinowitz
- Sandy Galef
- Richard Gottfried
- Aileen Gunther
- Andrew Hevesi
- Ellen C. Jaffee
- Charles Lavine
- Amy Paulin
- N. Nick Perry
- Robert J. Rodriguez
- Linda Rosenthal
- Jo Anne Simon
- Fred Thiele
- Kenneth Zebrowski
- William Colton
- Vivian Cook
- Felix Ortiz
- Michael Montesano
- Deborah Glick
- Robert C. Carroll
- Anthony D'Urso
- Marcos Crespo
- Aravella Simotas
- Carrie Woerner
- Al Taylor
- Phil Steck
- Walter T. Mosley
- Steven Otis
- Gary Finch
- Kenneth Blankenbush
- Michael Benedetto
- John T. McDonald III
- Jonathan Jacobson
- Clifford Crouch
- Joe DeStefano
3 Multi-sponsors
History
- Referred to insurance
- Delivered to senate
- Passed assembly
- Ordered to third reading cal.125
- Returned to assembly
- Died in senate
- Referred to insurance
- Delivered to senate
- Passed assembly
- Advanced to third reading cal.235
- Reported
- Reported referred to codes
Show 1 earlier action
- Referred to insurance
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3043
2019-2020 Regular Sessions
IN ASSEMBLY
January 28, 2019
Introduced by M. of A. JOYNER, AUBRY, BLAKE, BUCHWALD, CUSICK, CYMBROW- ITZ, DINOWITZ, GALEF, GOTTFRIED, GUNTHER, HEVESI, JAFFEE, LAVINE, PAULIN, PERRY, RODRIGUEZ, L. ROSENTHAL, SIMON, THIELE, ZEBROWSKI, COLTON, COOK, ORTIZ, MONTESANO, GLICK, CARROLL, D'URSO, CRESPO, SIMO- TAS, WOERNER, TAYLOR, STECK, MOSLEY -- Multi-Sponsored by -- M. of A. BRAUNSTEIN, CROUCH, NOLAN -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to the purchase of prescription drugs
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph 28 of subsection (i) of section 3216 of the insurance law, as amended by chapter 11 of the laws of 2012, is amended to read as follows:
(28) (A) Definitions. For the purpose of this paragraph:
(1) "Same reimbursement amount" shall mean that any coverage described under subparagraph (B) of this paragraph shall provide the same benchmark index, including the same average wholesale price, maximum allowable cost and national prescription drug codes to reimburse all pharmacies participating in the insurance network regardless of whether a pharmacy is a mail order pharmacy or a non-mail order pharmacy.
(2) "Mail order pharmacy" means a pharmacy whose primary business is to receive prescriptions by mail, telefax or through electronic submissions and to dispense medication to patients through the use of the United States mail or other common or contract carrier services and provides any consultation with patients electronically rather than faceto-face.
(B) Any policy that provides coverage for prescription drugs shall permit each insured to fill any covered prescription that may be obtained at a network participating mail order or other non-retail pharmacy, at the insured's option, at a network participating non-mail order
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00271-01-9
A. 3043 2
retail pharmacy provided that the network participating non-mail order retail pharmacy agrees [in advance, through a contractual network agreement,] to the same reimbursement amount[, as well as the same applicable terms and conditions,] that the insurer has established for the network participating mail order or other non-retail pharmacy. In such a case, the policy shall not impose a co-payment fee or other condition on any insured who elects to purchase prescription drugs from a network participating non-mail order retail pharmacy which is not also imposed on insureds electing to purchase drugs from a network participating mail order or other non-retail pharmacy.
§ 2. Paragraph 18 of subsection (l) of section 3221 of the insurance law, as amended by chapter 11 of the laws of 2012, is amended to read as follows:
(18) (A) Definitions. For the purpose of this paragraph:
(1) "Same reimbursement amount" shall mean that any coverage described under subparagraph (B) of this paragraph shall provide the same benchmark index, including the same average wholesale price, maximum allowable cost and national prescription drug codes to reimburse all pharmacies participating in the insurance network regardless of whether a pharmacy is a mail order pharmacy or a non-mail order pharmacy.
(2) "Mail order pharmacy" means a pharmacy whose primary business is to receive prescriptions by mail, telefax or through electronic submissions and to dispense medication to patients through the use of the United States mail or other common or contract carrier services and provides any consultation with patients electronically rather than faceto-face.
(B) Any insurer delivering a group or blanket policy or issuing a group or blanket policy for delivery in this state that provides coverage for prescription drugs shall permit each insured to fill any covered prescription that may be obtained at a network participating mail order or other non-retail pharmacy, at the insured's option, at a network participating non-mail order retail pharmacy provided that the network participating non-mail order retail pharmacy agrees [in advance, through a contractual network agreement,] to the same reimbursement amount[, as well as the same applicable terms and conditions,] that the insurer has established for the network participating mail order or other non-retail pharmacy. In such a case, the policy shall not impose a co-payment fee or other condition on any insured who elects to purchase drugs from a network participating non-mail order retail pharmacy which is not also imposed on insureds electing to purchase drugs from a network participating mail order or other non-retail pharmacy; provided, however, that the provisions of this section shall not supersede the terms of a collective bargaining agreement or apply to a policy that is the result of a collective bargaining agreement between an employer and a recognized or certified employee organization.
§ 3. Subsection (kk) of section 4303 of the insurance law, as amended by chapter 11 of the laws of 2012 and as relettered by section 55 of part D of chapter 56 of the laws of 2013, is amended to read as follows:
(kk) (1) Definitions. For the purpose of this subsection:
(A) "Same reimbursement amount" shall mean that any coverage described under paragraph two of this subsection shall provide the same benchmark index, including the same average wholesale price, maximum allowable cost and national prescription drug codes to reimburse all pharmacies participating in the health benefit plan regardless of whether a pharmacy is a mail order pharmacy or a non-mail order pharmacy.
A. 3043 3
(B) "Mail order pharmacy" means a pharmacy whose primary business is to receive prescriptions by mail, telefax or through electronic submissions and to dispense medication to patients through the use of the United States mail or other common or contract carrier services and provides any consultation with patients electronically rather than faceto-face.
(2) Any contract issued by a medical expense indemnity corporation, a hospital service corporation or a health services corporation that provides coverage for prescription drugs shall permit each covered person to fill any covered prescription that may be obtained at a network participating mail order or other non-retail pharmacy, at the covered person's option, at a network participating non-mail order retail pharmacy provided that the network participating non-mail order retail pharmacy agrees [in advance, through a contractual network agreement,] to the same reimbursement amount[, as well as the same applicable terms and conditions,] that the corporation has established for the network participating mail order or other non-retail pharmacy. In such a case, the contract shall not impose a copayment fee or other condition on any covered person who elects to purchase drugs from a network participating non-mail order retail pharmacy which is not also imposed on covered persons electing to purchase drugs from a network participating mail order or other non-retail pharmacy; provided, however, that the provisions of this section shall not supersede the terms of a collective bargaining agreement or apply to a contract that is the result of a collective bargaining agreement between an employer and a recognized or certified employee organization.
§ 4. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.