What's happening
This bill requires insurers to count third-party payments, discounts, and assistance toward patients' out-of-pocket prescription drug costs.
Why it matters
Ensures that financial help from charities, drug manufacturer coupons, and similar assistance actually counts toward what patients owe. helping patients reach their deductibles and out-of-pocket maximums faster, which can make affording medications easier.
Closes loopholes that let insurance companies ignore third-party support. when tallying patient spending, preventing insurers from requiring patients to pay more out-of-pocket than they otherwise would if all payments counted.
Could improve medication adherence and health outcomes. by reducing patients’ out-of-pocket burdens, especially for those with chronic conditions who rely on expensive prescriptions and assistance programs.
May impact insurance pricing and plan design. in the future, as insurers adjust to no longer being able to exclude these forms of patient assistance from cost-sharing calculations.
Albany, before your first meeting.
Every bill that moved yesterday, summarized in a sentence and ranked by impact. The Albany Scorecard follows on Sundays.
Free. Unsubscribe in one click. Want alerts on specific bills? Create an account.
Who cares
Insured patients using prescription drug assistance
The bill would require third-party payments, discounts, vouchers and other drug cost assistance to count toward their deductibles, copayments, coinsurance, out-of-pocket maximums and other cost-sharing requirements.
Health insurers and health service corporations
Covered policies and contracts would have to credit prescription drug assistance when calculating an insured individual's contribution toward cost-sharing requirements.
Organizations providing prescription drug financial assistance
Payments and price reductions they provide on behalf of insured patients would have to count toward those patients' cost-sharing requirements.
Headline styles
Count All Drug Payment Help
Plain English, a few words. Used as the page title.
Sponsors
History
- Referred to insurance
- Returned to senate
- Died in assembly
- Referred to insurance
- Delivered to assembly
- Passed senateVote 58–4
- Ordered to third reading cal.1443
- 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.
Count Copay Assistance Toward Max
In Assembly Committee · Insurance · Sponsor Richard Gottfried
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
6303
2019-2020 Regular Sessions
IN SENATE
June 3, 2019
Introduced by Sen. RIVERA -- 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 calculating an insured individual's overall contribution to any out-of-pocket maximum or any cost-sharing requirement
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 36 to read as follows:
(36) Any policy that provides coverage for prescription drugs shall apply any third-party payments, financial assistance, discount, voucher or other price reduction instrument for out-of-pocket expenses made on behalf of an insured individual for the cost of prescription drugs to the insured's deductible, copayment, coinsurance, out-of-pocket maximum, or any other cost-sharing requirement when calculating such insured individual's overall contribution to any out-of-pocket maximum or any cost-sharing requirement.
§ 2. Subsection (l) of section 3221 of the insurance law is amended by adding a new paragraph 21 to read as follows:
(21) Every group or blanket policy delivered or issued for delivery in this state that provides coverage for prescription drugs shall apply any third-party payments, financial assistance, discount, voucher or other price reduction instrument for out-of-pocket expenses made on behalf of an insured individual for the cost of prescription drugs to the insured's deductible, copayment, coinsurance, out-of-pocket maximum, or any other cost-sharing requirement when calculating such insured individual's overall contribution to any out-of-pocket maximum or any costsharing requirement.
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (ss) to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13146-01-9
S. 6303 2
(ss) Every contract issued by a medical expense indemnity corporation, hospital service corporation, or health service corporation that provides coverage for prescription drugs shall apply any third-party payments, financial assistance, discount, voucher or other price reduction instrument for out-of-pocket expenses made on behalf of an insured individual for the cost of prescription drugs to the insured's deductible, copayment, coinsurance, out-of-pocket maximum, or any other cost-sharing requirement when calculating such insured individual's overall contribution to any out-of-pocket maximum or any cost-sharing requirement.
§ 4. This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such date.
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 calculating an insured individual's overall contribution to any out-of- pocket maximum or any cost-sharing requirement
Purpose or general idea of bill
Requires insurance companies or pharmacy benefit managers to apply price reduction instruments for out-of-pocket expenses when calculating an insured individual's cost-sharing requirement.
Summary of provisions
Section 1 requires any individual insurance policy that provides cover- age for prescription drugs to apply any third party payments or other price reduction instruments for out-of-pocket expenses made on behalf of an insured person when calculating the insured individuals overall contribution to any out-of-pocket maximum or cost-sharing requirement.
Section 2 applies these same provisions to group or blanket policies that provide coverage for prescription drugs.
Section 3 applies these same provisions to non-profit medical expense indemnity policies, hospital service corporations or health service corporations that provides coverage for prescription drugs.
Justification
Recently, many insurance companies and pharmacy benefit managers have started to adopt new cost-shifting mechanisms that change the way an insured individual's out-of-pocket contributions for prescription drugs are calculated. These "copay accumulators" do not take into account any discounts or coupons that the insured person receives from the drug manufacturer when calculating the insured individuals out-of-pocket expenses.
Some insurance plans with a deductible require that the patient pay up to a certain amount of out-of-pocket expenses before the plan pays for all of the healthcare services. Many drug manufacturers, especially for high-cost drugs that treat rare diseases offer copay cards or other assistance to help pay for their prescription drugs. By not applying the discounts paid by the manufacturer, it takes the insured person longer to reach their deductible. This means that the insured person has to continue to pay copays for the drug for a longer period of time and may be paying significantly more in out-of-pocket expenses.
This practice shifts the cost towards patients as the insurance plan are essentially "double dipping" by requiring the patient to pay their normal copay and still receiving a discount or coupon from the drug manufacturer, while taking longer to satisfy their deductible.
Several states have already prohibited copay accumulators including Arizona, Virginia and West Virginia. Several other states have intro- duced legislation (Connecticut, Illinois, California, and others) that is currently moving through the legislative process that either limit or prohibit the use of "copay accumulators" by insurers.
Prior legislative history
New Bill
Fiscal implications
None to the state
Effective date
First of January next succeeding the date on which it shall become a law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.