Bill Text: NY A10293 | 2015-2016 | General Assembly | Introduced
Bill Title: Provides for reimbursement requirements and coverage for the purchase of prescription drugs through mail order pharmacies.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2016-05-20 - referred to insurance [A10293 Detail]
Download: New_York-2015-A10293-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 10293 IN ASSEMBLY May 20, 2016 ___________ Introduced by M. of A. JOYNER -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to reimbursements to mail order pharmacies The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraphs 13-a and 28 of subsection (i) of section 3216 of 2 the insurance law, paragraph 13-a as amended by chapter 10 of the laws 3 of 2012, paragraph 28 as amended by chapter 11 of the laws of 2012, are 4 amended to read as follows: 5 (13-a) (A) Definitions. For the purposes of this paragraph: 6 (1) "Same reimbursement amount" shall mean that any coverage described 7 under subparagraph (B) of this paragraph shall provide the same bench- 8 mark index, including the same average wholesale price, maximum allow- 9 able cost and national prescription drug codes to reimburse all pharma- 10 cies participating in the insurance network regardless of whether a 11 pharmacy is a mail order pharmacy or a non-mail order pharmacy. 12 (2) "Mail order pharmacy" shall mean a pharmacy whose primary business 13 is to receive prescriptions by mail, telefax or through electronic 14 submissions and to dispense medication to patients through the use of 15 the United States mail or other common or contract carrier services and 16 provides any consultation with patients electronically rather than face- 17 to-face. 18 (3) "Standard terms and conditions" shall mean the contractual terms 19 and conditions applicable to all network participating pharmacies that 20 were in effect on June first, two thousand fifteen; provided that if an 21 insurer has established different standard terms and conditions for mail 22 order pharmacies and non-mail order retail pharmacies, the term "stand- 23 ard terms and conditions" shall mean the standard terms and conditions 24 that were in effect on June first, two thousand fifteen for non-mail 25 order retail pharmacies, and provided further that any such standard 26 terms and conditions that require: 27 (i) consultation with a pharmacist shall not require such consultation 28 be available at non-mail order pharmacies outside of such pharmacy's EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD15299-04-6A. 10293 2 1 regular hours of operation and shall require mail order pharmacies to 2 provide such consultation twenty-four hours a day, seven days a week; 3 (ii) specific storage size for prescription drugs requiring special 4 handling, such as refrigeration, shall be based on the contracting phar- 5 macy's dispensing experience and shall not require a pharmacy to 6 increase its storage space when it has not been established that such 7 pharmacy's prescription volume requires such increased storage; and 8 (iii) specific storage space for prescription drugs that do not 9 require special handling shall be based on the contracting pharmacy's 10 physical size and dispensing experience and shall not require a pharmacy 11 to increase its storage space when it has not been established that such 12 pharmacy's prescription volume requires such increased storage. 13 (B) Every policy that provides coverage for prescription fertility 14 drugs and requires or permits prescription drugs to be purchased through 15 a network participating mail order or other non-retail pharmacy shall 16 provide the same coverage for prescription fertility drugs and shall not 17 limit the supply that may be dispensed to a thirty-day supply when such 18 drugs are purchased from a network participating non-mail order retail 19 pharmacy provided that the network participating non-mail order retail 20 pharmacy agrees [in advance through a contractual network agreement,] to 21 the same reimbursement amount[, as well as the same applicable terms and22conditions,] and standard terms and conditions that the insurer has 23 established for [a] network participating [mail order or other non-re-24tail pharmacy] pharmacies. In such case, the policy shall not impose 25 any fee, co-payment, co-insurance, deductible or other condition, 26 including requiring monthly refills of a prescription that was written 27 for and may be filled for more than a thirty-day supply, on any insured 28 who elects to purchase prescription fertility drugs through a network 29 participating non-mail order retail pharmacy that it does not impose on 30 any insured who purchases prescription fertility drugs through a network 31 participating mail order or other non-retail pharmacy. 32 (C) Any policy that provides coverage for prescription fertility drugs 33 shall, in addition to the standard terms and conditions, require mail 34 order pharmacies to replace dispensed prescription fertility drugs for 35 which the mail or carrier service has proof of delivery that have not 36 been received by the insured, or are spoiled or damaged, provided that 37 in the case of a prescription fertility drug that has not been received 38 by the insured, the policy may require that the insured provide proof of 39 theft in the form of a filed police report reporting the theft and in 40 the case of a damaged or spoiled prescription fertility drug, the policy 41 may require that the damaged prescription fertility drug be returned to 42 the mail order pharmacy with the cost to be borne by such pharmacy, and 43 provided further that such unreceived, spoiled or damaged prescription 44 fertility drug shall be replaced before receipt of the police report or 45 the returned, spoiled or damaged prescription fertility drug, as the 46 case may be. If such required police report is not provided or the 47 damaged or spoiled prescription fertility drug is not returned, the 48 policy may require the insured to reimburse the policy for the cost of 49 the prescription fertility drug and, notwithstanding the forgoing, when 50 an insured who was previously required to reimburse the plan for a 51 dispensed prescription fertility drug that was not received by the 52 insured, or was damaged or spoiled, the policy may refuse to replace 53 such prescription fertility drug for such insured until such insured has 54 provided the plan with the required police report or returned the 55 spoiled or damaged prescription fertility drug. Replacement of aA. 10293 3 1 prescription fertility drug pursuant to this subparagraph shall not be 2 limited to a specific number of occurrences during a contract year. 3 (28) (A) Definitions. For the purposes of this paragraph: 4 (1) "Same reimbursement amount" shall mean that any coverage described 5 under subparagraph (B) of this paragraph shall provide the same bench- 6 mark index, including the same average wholesale price, maximum allow- 7 able cost and national prescription drug codes to reimburse all pharma- 8 cies participating in the insurance network regardless of whether a 9 pharmacy is a mail order pharmacy or a non-mail order pharmacy. 10 (2) "Mail order pharmacy" shall mean a pharmacy whose primary business 11 is to receive prescriptions by mail, telefax or through electronic 12 submissions and to dispense medication to patients through the use of 13 the United States mail or other common or contract carrier services and 14 provides any consultation with patients electronically rather than face- 15 to-face. 16 (3) "Standard terms and conditions" shall mean the contractual terms 17 and conditions applicable to all network participating pharmacies that 18 were in effect on June first, two thousand fifteen; provided that if an 19 insurer has established different standard terms and conditions for mail 20 order pharmacies and non-mail order retail pharmacies, the term "stand- 21 ard terms and conditions" shall mean the standard terms and conditions 22 that were in effect on June first, two thousand fifteen for non-mail 23 order retail pharmacies, and provided further that any such standard 24 terms and conditions that require: 25 (i) consultation with a pharmacist shall not require such consultation 26 be available at non-mail order pharmacies outside of such pharmacy's 27 regular hours of operation and shall require mail order pharmacies to 28 provide such consultation twenty-four hours a day, seven days a week; 29 (ii) specific storage size for prescription drugs requiring special 30 handling, such as refrigeration, shall be based on the contracting phar- 31 macy's dispensing experience and shall not require a pharmacy to 32 increase its storage space when it has not been established that such 33 pharmacy's prescription volume requires such increased storage; and 34 (iii) specific storage space for prescription drugs that do not 35 require special handling shall base such requirements on the contracting 36 pharmacy's physical size and dispensing experience and shall not require 37 a pharmacy to increase its storage space when it has not been estab- 38 lished that such pharmacy's prescription volume requires such increased 39 storage. 40 (B) Any policy that provides coverage for prescription drugs shall 41 permit each insured to fill any covered prescription that may be 42 obtained at a network participating mail order or other non-retail phar- 43 macy, at the insured's option, at a network participating non-mail order 44 retail pharmacy provided that the network participating non-mail order 45 retail pharmacy agrees [in advance, through a contractual network agree-46ment,] to the same reimbursement amount[, as well as the same applicable47terms and conditions,] and standard terms and conditions that the insur- 48 er has established for the network participating [mail order or other49non-retail pharmacy] pharmacies. In such a case, the policy shall not 50 impose a co-payment fee or other condition, including requiring monthly 51 refills of a prescription that was written for and may be filled for 52 more than a thirty-day supply, on any insured who elects to purchase 53 prescription drugs from a network participating non-mail order retail 54 pharmacy which is not also imposed on insureds electing to purchase 55 drugs from a network participating mail order or other non-retail phar- 56 macy.A. 10293 4 1 (C) Any policy that provides coverage for prescription drugs shall, in 2 addition to the standard terms and conditions, require mail order phar- 3 macies to replace dispensed prescription drugs for which the mail or 4 carrier service has proof of delivery that have not been received by the 5 insured, or are spoiled or damaged, provided that in the case of a 6 prescription drug that has not been received by the insured, the policy 7 may require that the insured provide proof of theft in the form of a 8 filed police report reporting the theft and in the case of a damaged or 9 spoiled prescription drug, the policy may require that the damaged 10 prescription drug be returned to the mail order pharmacy with the cost 11 to be borne by such pharmacy, and provided further that such unreceived, 12 spoiled or damaged prescription drug shall be replaced before receipt of 13 the police report or the spoiled or damaged prescription drug, as the 14 case may be. If such required police report is not provided or the 15 damaged or spoiled prescription drug is not returned, the policy may 16 require the insured to reimburse the policy for the cost of the 17 prescription drug and, notwithstanding the forgoing, when an insured who 18 was previously required to reimburse the plan for a dispensed 19 prescription drug that was not received by the insured, or was damaged 20 or spoiled, the policy may refuse to replace such prescription drug for 21 such insured until such insured has provided the plan with the required 22 police report or retuned the spoiled or damaged prescription drug. 23 Replacement of a prescription drug pursuant to this subparagraph shall 24 not be limited to a specific number of occurrences during a contract 25 year. 26 § 2. Subparagraph (D) of paragraph 6 of subsection (k) of section 3221 27 of the insurance law, as amended by chapter 10 of the laws of 2012, is 28 amended to read as follows: 29 (D) (i) Definitions. For the purpose of this paragraph: 30 (1) "Same reimbursement amount" shall mean that any coverage described 31 under item (ii) of this subparagraph shall provide the same benchmark 32 index, including the same average wholesale price, maximum allowable 33 cost and national prescription drug codes to reimburse all pharmacies 34 participating in the insurance network regardless of whether a pharmacy 35 is a mail order pharmacy or a non-mail order pharmacy. 36 (2) "Mail order pharmacy" shall mean a pharmacy whose primary business 37 is to receive prescriptions by mail, telefax or through electronic 38 submissions and to dispense medication to patients through the use of 39 the United States mail or other common or contract carrier services and 40 provides any consultation with patients electronically rather than face- 41 to-face. 42 (3) "Standard terms and conditions" shall mean the contractual terms 43 and conditions applicable to all network participating pharmacies that 44 were in effect on June first, two thousand fifteen; provided that if an 45 insurer has established different standard terms and conditions for mail 46 order pharmacies and non-mail order retail pharmacies, the term standard 47 terms and conditions shall mean the standard terms and conditions that 48 were in effect on June first, two thousand fifteen for non-mail order 49 retail pharmacies, and provided further that any such standard terms and 50 conditions that require: 51 a. Consultation with a pharmacist shall not require such consultation 52 be available at non-mail order pharmacies outside of such pharmacy's 53 regular hours of operation and shall require mail order pharmacies to 54 provide such consultation twenty-four hours a day, seven days a week; 55 b. Specific storage size for prescription drugs requiring special 56 handling, such as refrigeration, shall be based on the contracting phar-A. 10293 5 1 macy's dispensing experience and shall not require a pharmacy to 2 increase its storage space when it has not been established that such 3 pharmacy's prescription volume requires such increased storage; and 4 c. Specific storage space for prescription drugs that do not require 5 special handling shall be based on the contracting pharmacy's physical 6 size and dispensing experience and shall not require a pharmacy to 7 increase its storage space when it has not been established that such 8 pharmacy's prescription volume requires such increased storage. 9 (ii) Every policy that provides coverage for prescription fertility 10 drugs and requires or permits prescription drugs to be purchased through 11 a network participating mail order or other non-retail pharmacy shall 12 provide the same coverage for prescription fertility drugs and shall not 13 limit the supply that may be dispensed to a thirty-day supply when such 14 drugs are purchased from a network participating non-mail order retail 15 pharmacy provided that the network participating non-mail order retail 16 pharmacy agrees [in advance through a contractual network agreement,] to 17 the same reimbursement amount[, as well as the same applicable terms and18conditions,] and standard terms and conditions that the insurer has 19 established for [a] network participating [mail order or other non-re-20tail pharmacy] pharmacies. In such case, the policy shall not impose any 21 fee, co-payment, co-insurance, deductible or other condition, including 22 requiring monthly refills of a prescription that was written for and may 23 be filled for more than a thirty-day supply, on any covered person who 24 elects to purchase prescription fertility drugs through a network 25 participating non-mail order retail pharmacy that it does not impose on 26 any covered person who purchases prescription fertility drugs through a 27 network participating mail order or other non-retail pharmacy; provided, 28 however, that the provisions of this section shall not supersede the 29 terms of a collective bargaining agreement or apply to a policy that is 30 the result of a collective bargaining agreement between an employer and 31 a recognized or certified employee organization. 32 (iii) Any policy that provides coverage for prescription fertility 33 drugs shall, in addition to the standard terms and conditions, require 34 mail order pharmacies to replace dispensed prescription fertility drugs 35 for which the mail or carrier service has proof of delivery that have 36 not been received by the insured, or are spoiled or damaged, provided 37 that in the case of a prescription fertility drug that has not been 38 received by the insured, the policy may require that the insured provide 39 proof of theft in the form of a filed police report reporting the theft 40 and in the case of a damaged or spoiled prescription fertility drug, the 41 policy may require that the damaged prescription fertility drug be 42 returned to the mail order pharmacy with the cost to be borne by such 43 pharmacy, and provided further that such unreceived, spoiled or damaged 44 prescription fertility drug shall be replaced before receipt of the 45 police report or the returned spoiled or damaged prescription fertility 46 drug, as the case may be. If such required police report is not provided 47 or the damaged or spoiled prescription fertility drug is not returned, 48 the policy may require the insured to reimburse the policy for the cost 49 of the prescription fertility drug and, notwithstanding the forgoing, 50 when an insured who was previously required to reimburse the plan for a 51 dispensed prescription fertility drug that was not received by the 52 insured, or was damaged or spoiled, the policy may refuse to replace 53 such prescription fertility drug for such insured until such insured has 54 provided the plan with the required police report or returned the 55 spoiled or damaged prescription fertility drug. Replacement of aA. 10293 6 1 prescription fertility drug pursuant to this clause shall not be limited 2 to a specific number of occurrences during a contract year. 3 § 3. Paragraph 18 of subsection (l) of section 3221 of the insurance 4 law, as amended by chapter 11 of the laws of 2012, is amended to read as 5 follows: 6 (18) (A) Definitions. For the purpose of this paragraph: 7 (1) "Same reimbursement amount" shall mean that any coverage described 8 under subparagraph (B) of this paragraph shall provide the same bench- 9 mark index, including the same average wholesale price, maximum allow- 10 able cost and national prescription drug codes to reimburse all pharma- 11 cies participating in the insurance network regardless of whether a 12 pharmacy is a mail order pharmacy or a non-mail order pharmacy. 13 (2) "Mail order pharmacy" shall mean a pharmacy whose primary business 14 is to receive prescriptions by mail, telefax or through electronic 15 submissions and to dispense medication to patients through the use of 16 the United States mail or other common or contract carrier services and 17 provides any consultation with patients electronically rather than face- 18 to-face. 19 (3) "Standard terms and conditions" shall mean the contractual terms 20 and conditions applicable to all network participating pharmacies that 21 were in effect on June first, two thousand fifteen; provided that if an 22 insurer has established different standard terms and conditions for mail 23 order pharmacies and non-mail order retail pharmacies, the term standard 24 terms and conditions shall mean the standard terms and conditions that 25 were in effect on June first, two thousand fifteen for non-mail order 26 retail pharmacies, and provided further that any such standard terms and 27 conditions that require: 28 (i) Consultation with a pharmacist shall not require such consultation 29 be available at non-mail order pharmacies outside of such pharmacy's 30 regular hours of operation and shall require mail order pharmacies to 31 provide such consultation twenty-four hours a day, seven days a week; 32 (ii) Specific storage size for prescription drugs requiring special 33 handling, such as refrigeration, shall be based on the contracting phar- 34 macy's dispensing experience and shall not require a pharmacy to 35 increase its storage space when it has not been established that such 36 pharmacy's prescription volume requires such increased storage; and 37 (iii) Specific storage space for prescription drugs that do not 38 require special handling shall base such requirements on the contracting 39 pharmacy's physical size and dispensing experience and shall not require 40 a pharmacy to increase its storage space when it has not been estab- 41 lished that such pharmacy's prescription volume requires such increased 42 storage. 43 (B) Any insurer delivering a group or blanket policy or issuing a 44 group or blanket policy for delivery in this state that provides cover- 45 age for prescription drugs shall permit each insured to fill any covered 46 prescription that may be obtained at a network participating mail order 47 or other non-retail pharmacy, at the insured's option, at a network 48 participating non-mail order retail pharmacy provided that the network 49 participating non-mail order retail pharmacy [agrees in advance, through50a contractual network agreement,] to the same reimbursement amount[, as51well as the same applicable terms and conditions,] and standard terms 52 and conditions that the insurer has established for the network partic- 53 ipating [mail order or other non-retail pharmacy] pharmacies. In such a 54 case, the policy shall not impose a co-payment fee or other condition, 55 including requiring monthly refills of a prescription that was written 56 for and may be filled for more than a thirty-day supply, on any insuredA. 10293 7 1 who elects to purchase drugs from a network participating non-mail order 2 retail pharmacy which is not also imposed on insureds electing to 3 purchase drugs from a network participating mail order or other non-re- 4 tail pharmacy; provided, however, that the provisions of this section 5 shall not supersede the terms of a collective bargaining agreement or 6 apply to a policy that is the result of a collective bargaining agree- 7 ment between an employer and a recognized or certified employee organ- 8 ization. 9 (C) Any policy that provides coverage for prescription drugs shall, in 10 addition to the standard terms and conditions, require mail order phar- 11 macies to replace dispensed prescription drugs for which the mail or 12 carrier service has proof of delivery that have not been received by the 13 insured, or are spoiled or damaged, provided that in the case of a 14 prescription drug that has not been received by the insured, the policy 15 may require that the insured provide proof of theft in the form of a 16 filed police report reporting the theft and in the case of a damaged or 17 spoiled prescription drug, the policy may require that the damaged 18 prescription drug be returned to the mail order pharmacy with the cost 19 to be borne by such pharmacy, and provided further that such unreceived, 20 spoiled or damaged prescription drug shall be replaced before receipt of 21 the police report or the spoiled or damaged prescription drug, as the 22 case may be. If such required police report is not provided or the 23 damaged or spoiled prescription drug is not returned, the policy may 24 require the insured to reimburse the policy for the cost of the 25 prescription drug and, notwithstanding the forgoing, when an insured who 26 was previously required to reimburse the plan for a dispensed 27 prescription drug that was not received by the insured, or was damaged 28 or spoiled, the policy may refuse to replace such prescription drug for 29 such insured until such insured has provided the plan with the required 30 police report or returned the spoiled or damaged prescription drug. 31 Replacement of a prescription drug pursuant to this subparagraph shall 32 not be limited to a specific number of occurrences during a contract 33 year. 34 § 4. Paragraph 4 of subsection (s) of section 4303 of the insurance 35 law, as amended by chapter 10 of the laws of 2012, is amended to read as 36 follows: 37 (4) (A) Definition. For the purpose of this paragraph: 38 (i) "Same reimbursement amount" shall mean that any coverage described 39 under subparagraph (B) of this subsection shall provide the same bench- 40 mark index, including the same average wholesale price, maximum allow- 41 able cost and national prescription drug codes to reimburse all pharma- 42 cies participating in the insurance network regardless of whether a 43 pharmacy is a mail order pharmacy or a non-mail order pharmacy. 44 (ii) "Mail order pharmacy" shall mean a pharmacy whose primary busi- 45 ness is to receive prescriptions by mail, telefax or through electronic 46 submissions and to dispense medication to patients through the use of 47 the United States mail or other common or contract carrier services and 48 provides any consultation with patients electronically rather than face- 49 to-face. 50 (iii) "Standard terms and conditions" shall mean the contractual terms 51 and conditions applicable to all network participating pharmacies that 52 were in effect on June first, two thousand fifteen; provided that if an 53 insurer had established different standard terms and conditions for mail 54 order pharmacies and non-mail order retail pharmacies, the term standard 55 terms and conditions shall mean the standard terms and conditions that 56 were in effect on June first, two thousand fifteen for non-mail orderA. 10293 8 1 retail pharmacies, and provided further that any such standard terms and 2 conditions that require: 3 (I) Consultation with a pharmacist shall not require such consultation 4 be available at non-mail order pharmacies outside of such pharmacy's 5 regular hours of operation and shall require mail order pharmacies to 6 provide such consultation twenty-four hours a day, seven days a week; 7 (II) Specific storage space for prescription drugs require special 8 handling, such as refrigeration, shall be based on the contracting phar- 9 macy's dispensing experience and shall not require a pharmacy to 10 increase its storage space when it has not been established that such 11 pharmacy's prescription volume requires such increased storage; and 12 (III) Specific storage space for prescription drugs that do not 13 require special handling shall be based on on the contracting pharmacy's 14 physical size and dispensing experience and shall not require a pharmacy 15 to increase its storage space when it has not been established that such 16 pharmacy's prescription volume requires such increased storage. 17 (B) Every contract issued by a medical expense indemnity corporation, 18 a hospital service corporation or a health services corporation that 19 provides coverage for prescription fertility drugs and requires or 20 permits prescription drugs to be purchased through a network participat- 21 ing mail order or other non-retail pharmacy shall provide the same 22 coverage for prescription fertility drugs and shall not limit the supply 23 that may be dispensed to a thirty-day supply when such drugs are 24 purchased from a network participating non-mail order retail pharmacy 25 provided that the network participating non-mail order retail pharmacy 26 agrees [in advance, through a contractual network agreement,] to the 27 same reimbursement amount[, as well as the same applicable terms and28conditions,] and standard terms and conditions that the corporation has 29 established for the network participating [mail order or other non-re-30tail pharmacy] pharmacies. In such case, the contract shall not impose 31 any fee, co-payment, co-insurance, deductible or other condition, 32 including requiring monthly refills of a prescription that was written 33 for and may be filled for more than a thirty-day supply, on any covered 34 person who does not elect to purchase prescription fertility drugs 35 through a network participating mail order or other non-retail pharmacy; 36 provided, however, that the provisions of this section shall not super- 37 sede the terms of a collective bargaining agreement or apply to a 38 contract that is the result of a collective bargaining agreement between 39 an employer and a recognized or certified employee organization. 40 (3) Any policy that provides coverage for prescription fertility drugs 41 shall, in addition to the standard terms and conditions, require mail 42 order pharmacies to replace dispensed prescription fertility drugs for 43 which the mail or carrier service has proof of delivery that have been 44 not received by the insured, or are spoiled or damaged, provided that in 45 the case of a prescription fertility drug that has not been received by 46 the insured, the policy may require that the insured provide proof of 47 theft in the form of a filed police report reporting the theft and in 48 the case of a damaged or spoiled prescription fertility drug, the policy 49 may require that the damaged prescription fertility drug be returned to 50 the mail order pharmacy with the cost to be borne by such pharmacy, and 51 provided further that such unreceived, spoiled or damaged prescription 52 fertility drug shall be replaced before receipt of the police report or 53 the spoiled or damaged prescription fertility drug, as the case may be. 54 If such required police report is not provided or the damaged or spoiled 55 prescription fertility drug is not returned, the policy may require the 56 insured to reimburse the policy for the cost of the prescription fertil-A. 10293 9 1 ity drug and, notwithstanding the forgoing, when an insured who was 2 previously required to reimburse the plan for a dispensed prescription 3 fertility drug that was not received by the insured, or was damaged or 4 spoiled, the policy may refuse to replace such prescription fertility 5 drug for such insured until such insured has provided the plan with the 6 required police report or returned the spoiled or damaged prescription 7 fertility drug. Replacement of a prescription fertility drug pursuant to 8 this paragraph shall not be limited to a specific number of occurrences 9 during a contract year. 10 § 5. Subsection (kk) of section 4303 of the insurance law, as amended 11 by chapter 11 of the laws of 2012 and as relettered by section 55 of 12 part D of chapter 56 of the laws of 2013, is amended to read as follows: 13 (kk) (1) Definitions. For the purpose of this subsection: 14 (A) "Same reimbursement amount" shall mean that any coverage described 15 under paragraph two of this subsection shall provide the same benchmark 16 index, including the same average wholesale price, maximum allowable 17 cost and national prescription drug codes to reimburse all pharmacies 18 participating in the insurance network regardless of whether a pharmacy 19 is a mail order pharmacy or a non-mail order pharmacy. 20 (B) "Mail order pharmacy" shall mean a pharmacy whose primary business 21 is to receive prescriptions by mail, telefax or through electronic 22 submissions and to dispense medication to patients through the use of 23 the United States mail or other common or contract carrier services and 24 provides any consultation with patients electronically rather than face- 25 to-face. 26 (C) "Standard terms and conditions" shall mean the contractual terms 27 and conditions applicable to all network participating pharmacies that 28 were in effect on June first, two thousand fifteen; provided that if an 29 insurer has established different standard terms and conditions for mail 30 order pharmacies and non-mail order retail pharmacies, the term standard 31 terms and conditions shall mean the standard terms and conditions that 32 were in effect on June first, two thousand fifteen for non-mail order 33 retail pharmacies, and provided further that any such standard terms and 34 conditions that require: 35 (i) Consultation with a pharmacist shall not require such consultation 36 be available at non-mail order pharmacies outside of such pharmacy's 37 regular hours of operation and shall require mail order pharmacies to 38 provide such consultation twenty-four hours a day, seven days a week; 39 (ii) Specific storage size for prescription drugs requiring special 40 handling, such as refrigeration, shall be based on the contracting phar- 41 macy's dispensing experience and shall not require a pharmacy to 42 increase its storage space when it has not been established that such 43 pharmacy's prescription volume requires such increased storage; and 44 (iii) Specific storage space for prescription drugs that do not 45 require special handling shall be based on the contracting pharmacy's 46 physical size and dispensing experience and shall not require a pharmacy 47 to increase its storage space when it has not been established that such 48 pharmacy's prescription volume requires such increased storage. 49 (2) Any contract issued by a medical expense indemnity corporation, a 50 hospital service corporation or a health services corporation that 51 provides coverage for prescription drugs shall permit each covered 52 person to fill any covered prescription that may be obtained at a 53 network participating mail order or other non-retail pharmacy, at the 54 covered person's option, at a network participating non-mail order 55 retail pharmacy provided that the network participating non-mail order 56 retail pharmacy agrees [in advance, through a contractual network agree-A. 10293 10 1ment,] to the same reimbursement amount[, as well as the same applicable2terms and conditions,] and standard terms and conditions that the corpo- 3 ration has established for the network participating [mail order or4other non-retail pharmacy] pharmacies. In such a case, the contract 5 shall not impose a copayment fee or other condition, including requiring 6 monthly refills of a prescription that was written for and may be filled 7 for more than a thirty-day supply, on any covered person who elects to 8 purchase drugs from a network participating non-mail order retail phar- 9 macy which is not also imposed on covered persons electing to purchase 10 drugs from a network participating mail order or other non-retail phar- 11 macy; provided, however, that the provisions of this section shall not 12 supersede the terms of a collective bargaining agreement or apply to a 13 contract that is the result of a collective bargaining agreement between 14 an employer and a recognized or certified employee organization. 15 (3) Any policy that provides coverage for prescription drugs shall, in 16 addition to the standard terms and conditions, require mail order phar- 17 macies to replace dispensed prescription drugs for which the mail or 18 carrier service has proof of delivery that have not been received by the 19 insured, or are spoiled or damaged, provided that in the case of a 20 prescription drug that has not been received by the insured, the policy 21 may require that the insured provide proof of theft in the form of a 22 filed police report reporting theft and in the case of a damaged or 23 spoiled prescription drug, the policy may require that the damaged 24 prescription drug be returned to the mail order pharmacy with the cost 25 to be borne by such pharmacy, and provided further that such unreceived, 26 spoiled or damaged prescription drug shall be replaced before receipt of 27 the police report or the spoiled or damaged prescription drug, as the 28 case may be. If such required police report is not provided or the 29 damaged or spoiled prescription drug is not returned, the policy may 30 require the insured to reimburse the policy for the cost of the 31 prescription drug and, notwithstanding the forgoing, when an insured who 32 was previously required to reimburse the plan for a dispensed 33 prescription drug that was not received by the insured, or was damaged 34 or spoiled, the policy may refuse to replace such prescription drug for 35 such insured until such insured has provided the plan with the required 36 police report or returned the spoiled or damaged prescription drug. 37 Replacement of a prescription drug pursuant to this paragraph shall not 38 be limited to a specific number of occurrences during a contract year. 39 § 6. Severability. If any clause, sentence, paragraph, section or part 40 of this act shall be adjudged by any court of competent jurisdiction to 41 be invalid, the judgement shall not affect, impair, or invalidate the 42 remainder thereof, but shall be confined in its operation to the clause, 43 sentence, paragraph, section or part thereof directly involved in the 44 controversy in which the judgement shall have been rendered. 45 § 7. This act shall take effect immediately.
