What's happening
This bill allows prescribers to require prescriptions be filled at retail pharmacies instead of mail order when justified by patient needs, with insurer consultation.
Why it matters
Empowers prescribers to make case-by-case decisions. The bill gives healthcare providers the authority to override default mail-order requirements if specific patient needs—such as medical condition, living situation, or ability to receive/understand guidance—make retail pharmacy pickup more appropriate.
Requires insurer consultation but prioritizes patient care. Prescribers must consult with insurers about whether mail order is suitable, but once a determination is made in favor of retail pickup for legitimate reasons, that decision is final and binding.
Protects patient access without raising costs. Retail pharmacies chosen by patients must accept the same reimbursement as mail order, ensuring that greater access or flexibility for patients doesn’t come with higher expenses for insurers or patients.
Addresses practical and safety concerns. By considering factors like drug storage needs and the patient's ability to receive shipments or comprehend phone-based support, the bill aims to reduce medication errors, spoilage, or missed doses that can result from rigid mail-order policies.
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Who cares
Insured patients
Patients facing delivery, medical, drug-storage or telephone-guidance difficulties could obtain prescriptions at an eligible in-network retail pharmacy they choose when their prescriber determines retail dispensing is most appropriate.
Prescribers
After consulting with the insurer about the suitability of mail delivery, prescribers would have final say on retail dispensing if the pharmacy meets the bill’s conditions.
In-network retail pharmacies
Pharmacies could fill these prescriptions if they agree to the same reimbursement amount and are able to fill the prescription.
Health insurers
Insurers would be consulted about mail delivery but would have to accept the prescriber’s determination when the bill’s conditions are met.
Headline styles
Let Retail Pharmacies Fill Prescriptions
Plain English, a few words. Used as the page title.
Sponsors
10 Co-sponsors
2 Multi-sponsors
History
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Let Pharmacies Fill Mail Prescriptions
In Senate Committee · Insurance · Sponsor James Skoufis
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
347
2019-2020 Regular Sessions
IN ASSEMBLY (Prefiled)
January 9, 2019
Introduced by M. of A. JOYNER, COLTON, ORTIZ, COOK, GLICK, D'URSO, GOTT- FRIED -- Multi-Sponsored by -- M. of A. THIELE, WRIGHT -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to coverage of prescriptions obtained by mail order or at a non-retail pharmacy
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. The opening paragraph of paragraph 28 of subsection (i) of section 3216 of the insurance law, as added by chapter 589 of the laws of 2011, is designated subparagraph (A) and a new subparagraph (B) is added to read as follows:
(B) Notwithstanding any other provision of this paragraph, if a prescriber, after consulting with the insurer regarding the appropriateness of mail order delivery given: (i) the residence or delivery location of the insured; (ii) the medical condition of the insured; (iii) the storage requirements of the drug; (iv) the availability of the insured to receive the prescription; or (v) the insured's ability to comprehend pharmaceutical guidance and support over the telephone, determines that a drug as prescribed on an individual basis is most appropriately filled at a retail location, provided that an in-network retail pharmacy of the patient's choosing agrees to the same reimbursement amount and is able to fill the prescription, the prescriber's determination shall be final.
§ 2. The opening paragraph of paragraph 18 of subsection (l) of section 3221 of the insurance law is designated subparagraph (A) and a new subparagraph (B) is added to read as follows:
(B) Notwithstanding any other provision of this paragraph, if a prescriber, after consulting with the insurer regarding the appropriateness of mail order delivery given: (i) the residence or delivery location of the insured; (ii) the medical condition of the insured; (iii) the storage requirements of the drug; (iv) the availability of the insured to
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00064-02-9
A. 347 2
receive the prescription; or (v) the insured's ability to comprehend pharmaceutical guidance and support over the telephone, determines that a drug as prescribed on an individual basis is most appropriately filled at a retail location, provided that an in-network retail pharmacy of the patient's choosing agrees to the same reimbursement amount and is able to fill the prescription, the prescriber's determination shall be final.
§ 3. The opening paragraph of subsection (kk) of section 4303 of the insurance law is designated paragraph 1 and a new paragraph 2 is added to read as follows:
(2) Notwithstanding any other provision of this subsection, if a prescriber, after consulting with the insurer regarding the appropriateness of mail order delivery given: (A) the residence or delivery location of the covered person; (B) the medical condition of the covered person; (C) the storage requirements of the drug; (D) the availability of the covered person to receive the prescription; or (E) the covered person's ability to comprehend pharmaceutical guidance and support over the telephone, determines that a drug as prescribed on an individual basis is most appropriately filled at a retail location, provided that an in-network retail pharmacy of the patient's choosing agrees to the same reimbursement amount and is able to fill the prescription, the prescriber's determination shall be final.
§ 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.