STATE OF NEW YORK ________________________________________________________________________ 3566 2021-2022 Regular Sessions IN SENATE January 30, 2021 ___________ Introduced by Sens. BRESLIN, ADDABBO, MAY -- read twice and ordered printed, and when printed to be committed to the Committee on Insur- ance 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 Assem- bly, do enact as follows: 1 Section 1. Paragraph 28 of subsection (i) of section 3216 of the 2 insurance law, as amended by chapter 11 of the laws of 2012, is amended 3 to read as follows: 4 (28) (A) Definitions. For the purpose of this paragraph: 5 (i) "Same reimbursement amount" shall mean that any coverage described 6 under subparagraph (B) of this paragraph shall provide the same bench- 7 mark index, including the same average wholesale price, maximum allow- 8 able cost and national prescription drug codes to reimburse all pharma- 9 cies participating in the insurance network regardless of whether a 10 pharmacy is a mail order pharmacy or a non-mail order pharmacy. 11 (ii) "Mail order pharmacy" means a pharmacy whose primary business is 12 to receive prescriptions by mail, telefax or through electronic 13 submissions and to dispense medication to patients through the use of 14 the United States mail or other common or contract carrier services and 15 provides any consultation with patients electronically rather than face- 16 to-face. 17 (B) Any policy that provides coverage for prescription drugs shall 18 permit each insured to fill any covered prescription that may be 19 obtained at a network participating mail order or other non-retail phar- 20 macy, at the insured's option, at a network participating non-mail order 21 retail pharmacy provided that the network participating non-mail order 22 retail pharmacy agrees [~~in advance, through a contractual network agree-~~ 23 ~~ment,~~] to the same reimbursement amount[~~, as well as the same applicable~~ 24 ~~terms and conditions,~~] that the insurer has established for the network EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD03918-02-1

S. 3566 2 1 participating mail order or other non-retail pharmacy. In such a case, 2 the policy shall not impose a co-payment fee or other condition on any 3 insured who elects to purchase prescription drugs from a network partic- 4 ipating non-mail order retail pharmacy which is not also imposed on 5 insureds electing to purchase drugs from a network participating mail 6 order or other non-retail pharmacy; provided, however, that the 7 provisions of this subparagraph shall not supersede the terms of a 8 collective bargaining agreement or apply to a policy that is a result of 9 a collective bargaining agreement between an employer and a recognized 10 or certified employee organization. 11 § 2. Paragraph 18 of subsection (l) of section 3221 of the insurance 12 law, as amended by chapter 11 of the laws of 2012, is amended to read as 13 follows: 14 (18) (A) Definitions. For the purpose of this paragraph: 15 (i) "Same reimbursement amount" shall mean that any coverage described 16 under subparagraph (B) of this paragraph shall provide the same bench- 17 mark index, including the same average wholesale price, maximum allow- 18 able cost and national prescription drug codes to reimburse all pharma- 19 cies participating in the insurance network regardless of whether a 20 pharmacy is a mail order pharmacy or a non-mail order pharmacy. 21 (ii) "Mail order pharmacy" means a pharmacy whose primary business is 22 to receive prescriptions by mail, telefax or through electronic 23 submissions and to dispense medication to patients through the use of 24 the United States mail or other common or contract carrier services and 25 provides any consultation with patients electronically rather than face- 26 to-face. 27 (B) Any insurer delivering a group or blanket policy or issuing a 28 group or blanket policy for delivery in this state that provides cover- 29 age for prescription drugs shall permit each insured to fill any covered 30 prescription that may be obtained at a network participating mail order 31 or other non-retail pharmacy, at the insured's option, at a network 32 participating non-mail order retail pharmacy provided that the network 33 participating non-mail order retail pharmacy agrees [~~in advance, through~~ 34 ~~a contractual network agreement,~~] to the same reimbursement amount[~~, as~~ 35 ~~well as the same applicable terms and conditions,~~] that the insurer has 36 established for the network participating mail order or other non-retail 37 pharmacy. In such a case, the policy shall not impose a co-payment fee 38 or other condition on any insured who elects to purchase drugs from a 39 network participating non-mail order retail pharmacy which is not also 40 imposed on insureds electing to purchase drugs from a network partic- 41 ipating mail order or other non-retail pharmacy; provided, however, that 42 the provisions of this section shall not supersede the terms of a 43 collective bargaining agreement or apply to a policy that is the result 44 of a collective bargaining agreement between an employer and a recog- 45 nized or certified employee organization. 46 § 3. Subsection (kk) of section 4303 of the insurance law, as amended 47 by chapter 11 of the laws of 2012 and as relettered by section 55 of 48 part D of chapter 56 of the laws of 2013, is amended to read as follows: 49 (kk) (1) Definitions. For the purpose of this subsection: 50 (A) "Same reimbursement amount" shall mean that any coverage described 51 under paragraph two of this subsection shall provide the same benchmark 52 index, including the same average wholesale price, maximum allowable 53 cost and national prescription drug codes to reimburse all pharmacies 54 participating in the health benefit plan regardless of whether a pharma- 55 cy is a mail order pharmacy or a non-mail order pharmacy.

S. 3566 3 1 (B) "Mail order pharmacy" means a pharmacy whose primary business is 2 to receive prescriptions by mail, telefax or through electronic 3 submissions and to dispense medication to patients through the use of 4 the United States mail or other common or contract carrier services and 5 provides any consultation with patients electronically rather than face- 6 to-face. 7 (2) Any contract issued by a medical expense indemnity corporation, a 8 hospital service corporation or a health services corporation that 9 provides coverage for prescription drugs shall permit each covered 10 person to fill any covered prescription that may be obtained at a 11 network participating mail order or other non-retail pharmacy, at the 12 covered person's option, at a network participating non-mail order 13 retail pharmacy provided that the network participating non-mail order 14 retail pharmacy agrees [~~in advance, through a contractual network agree-~~ 15 ~~ment,~~] to the same reimbursement amount[~~, as well as the same applicable~~ 16 ~~terms and conditions,~~] that the corporation has established for the 17 network participating mail order or other non-retail pharmacy. In such 18 a case, the contract shall not impose a copayment fee or other condition 19 on any covered person who elects to purchase drugs from a network 20 participating non-mail order retail pharmacy which is not also imposed 21 on covered persons electing to purchase drugs from a network participat- 22 ing mail order or other non-retail pharmacy; provided, however, that the 23 provisions of this section shall not supersede the terms of a collective 24 bargaining agreement or apply to a contract that is the result of a 25 collective bargaining agreement between an employer and a recognized or 26 certified employee organization. 27 § 4. This act shall take effect immediately.

Relates to the purchase of prescription drugs

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