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NY S03231
Bill
Status
1/28/2021
Primary Sponsor
James Sanders
Click for details
AI Summary
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Prohibits health care plans and insurers from including "most favored nation" clauses that allow reimbursement at the lowest price charged to any other person or entity for the same treatment or procedure.
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Prohibits health care plans and insurers from restricting health care providers' ability to refer patients or enrollees to providers based solely on their participation status with the patient's managed care product or insurance plan.
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Prohibits health care plans and insurers from allowing substitution of prescribed pharmaceutical drugs or agents (except for generic substitutions) by anyone other than the prescribing health care professional or a pharmacist under specified education law provisions.
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Applies these restrictions to health maintenance organizations under Public Health Law Section 4406-c, health insurers under Insurance Law Section 3217-b, and health insurers under Insurance Law Section 4325.
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Takes effect 180 days after becoming law.
Legislative Description
Relates to certain prohibitions in contracts or agreements by health maintenance organizations; prohibits clauses which entitle reimbursement at the lowest price or rate; prohibits contracts which restrict referral of patients based solely upon a health care provider's status with a managed care product; prohibits contracts which allow for the substitution of a pharmaceutical drug or agent by any person other than the prescribing health care professional.
Last Action
COMMITTED TO RULES
6/3/2022