What's happening
This bill allows prescribers, after insurer consultation, to require prescriptions be filled at retail pharmacies instead of mail order if appropriate for the patient.
Why it matters
Empowers prescribers to decide, for individual patients, whether mail order or retail pharmacy is more appropriate. based on factors like living situation, medical condition, drug storage needs, patient availability, and ability to understand instructions over the phone—potentially improving patient safety and medication adherence.
Requires insurers to consult with prescribers before defaulting to mail order delivery. , ensuring that the unique needs and circumstances of each patient are considered rather than applying a one-size-fits-all approach.
Allows patients to use their preferred in-network retail pharmacy if it matches the mail order reimbursement rate and can fill the prescription. , which could increase patient convenience, support local pharmacies, and provide more immediate access to medications.
Makes the prescriber's judgment final in these cases. , shifting authority away from insurers and pharmacy benefit managers, and potentially reducing bureaucratic delays for patients needing timely medication access.
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Who cares
Headline styles
Let Pharmacies Fill Mail Prescriptions
Plain English, a few words. Used as the page title.
Sponsors
Senator · Senate District 39
No co-sponsors yet.
History
- Referred to insurance
- Referred to rules
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 Retail Pharmacies Fill Prescriptions
In Assembly Committee · Insurance · Sponsor Latoya Joyner
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
6296
2019-2020 Regular Sessions
IN SENATE
June 3, 2019
Introduced by Sen. SKOUFIS -- read twice and ordered printed, and when printed to be committed to the Committee on Rules
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 receive the prescription; or (v) the insured's ability to comprehend pharmaceutical guidance and support over the telephone, determines that
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00064-02-9
S. 6296 2
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.
Sponsor's memo
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 or general idea of bill
Ensure patient access to retail pharmacies upon the prescriber's deter- mination 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 resi- dence, 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 the retail pharmacy agrees to the same reimbursement amount and is able to fill the prescription, the prescriber's 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 pharmacist. 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.
Prior legislative history
Assembly 2016 (Al 0290A) - Referred to Insurance 2017-18 (A1929) - Referred to Insurance Senate 2016 (A7595A) - Referred to Insurance
Fiscal implications
None to the state
Effective date
This act shall take effect immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.