BILL NUMBER: S6168
SPONSOR: PARKER
 
TITLE OF BILL:
An act to amend the insurance law, in relation to coverage for single
source drugs
 
PURPOSE OR GENERAL IDEA OF BILL:
Requires continued coverage of a prescription drug if a patient was on
such drug prior to a policy change.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section one adds a new paragraph 39 to subsection (1) of § 3216 of the
insurance law to require continued coverage of a prescription drug if
such drug was previously covered under an individual's insurance plan
and no generic equivalent is available.
Section two adds a new paragraph 23 to subsection (k) of § 3221 of the
insurance law requiring each group policy to continue coverage of a
prescription drug during a grievance or an appeal when a policy removes
a prescription from the formulary while patient was taking such drug as
part of a prescribed therapy.
Section three adds a new subsection uu to § 4303 of the insurance law
requiring contracts issued by a health service corporation or a medical
expense indemnity corporation to continue coverage of a prescription
drug during a grievance or an appeal when a policy removes a
prescription from the formulary while the patient was taking such drug
as part of a prescribed therapy.
Section four contains the effective date.
 
JUSTIFICATION:
This legislation was modeled after a 1998 law in California. This bill
would require an insurance plan to continue their coverage of
prescription medication for patients currently taking the medication
when no generic equivalent is available. When a patient is on a
prescribed therapy it is very important for the patient to maintain that
therapy to the end. When a drug is dropped from a plan, the consequences
can be dire and/or costly for the patients that are in various stages of
therapy with that drug. If the patient were to maintain the prescribed
therapy, the out of pocket cost to the patient: could be so exorbitant.
that the patient would eventually stop taking the prescription prior to
the completion of the therapy.
In another circumstance, the patient may be forced to change to a simi-
lar brand name drug -that is covered under the plan- in the midst of the
prescribed therapy. That new drug may not be as suitable or may cause
adverse reactions. The new drug may not react well with other medication
that the patient is taking. Also, the new drug tua'y pot achieve the
desired effect that the other drug accomplished. The physician should
have the final say in which prescription a patient. takes. Although one
drug may seem to have the same effect as another, it may not be as
compatible with other medications a patient is taking or, one drug may
be more effective under certain conditions. In any event, health care
cannot be directed by the bottom dollar in every instance. When a
patient's wellbeing is affected, policy must be changed for the better-
ment of the patient.
 
LEGISLATIVE HISTORY:
2023-24: S7344- Referred to Insurance
2021-22: S5901 - Referred to Insurance
2019-20: S8105- Referred to Insurance
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
This act shall take effect on the first day of the calendar month next
succeeding the sixtieth day after it shall have become a law; provided,
however, that this act shall apply only to policies and contracts
issued, renewed or amended on or after such effective date.

Statutes affected:
S6168: 3216 insurance law, 3216(i) insurance law, 3221 insurance law, 3221(k) insurance law, 4303 insurance law