State Senator Gustavo Rivera - Senate Majority Advances Legislation to Make Prescription Drugs More Affordable

 Yesterday, the Senate Democratic Majority advanced legislation to improve the accessibility and affordability of prescription drugs for all New Yorkers. The proposed bills would reduce the cap on cost-sharing for insulin from $100 to $30 per month, assist seniors with prescription fees, and make all third-party discounts, vouchers, and financial assistance for prescription drugs made on behalf of the insured individual applicable to their co-payment, deductible, co-insurance, and out-of-pocket maximum. Given the new legislation, seniors will now be eligible for the Elderly Pharmaceutical Insurance Coverage Program if they have enrolled in the Medicare Part D insurance plan and any other comparable plan. 

In addition to cost-saving initiatives, the legislation will also promote prescription drug awareness and provide information on cost-increase measures. One bill requires pharmaceutical companies to offer a sixty-day notice of their intent to raise the cost of a prescription drug if the increase is greater than 10%. In 2016, when Mylan increased the cost of their two-package Auto-Injectors from $100 to $600 per package, thousands of Americans were left wondering how they could afford this life-saving drug. There are at least 90,000 emergency room visits due to anaphylactic shock every year.

“The high cost of insulin is putting the lives of diabetic New Yorkers at risk, especially those who are financially strained, today we are reducing the cap on cost-sharing for insulin from the current $100 to $30 per month. The other bills I'm sponsoring in this package will make crucial reforms to third-party payments for co-pays and reform the eligibility criteria for the EPIC program to help a greater number of our seniors afford their prescriptions. I'd like to thank Majority Leader Andrea Stewart-Cousins for supporting this legislation that will continue to expand access and affordability of prescription drugs for New Yorkers,” Chair of the Senate Committee on Health, Senator Gustavo Rivera.

The legislation that was passed by the Senate Majority included: 

•   Cap On Cost Sharing For Insulin: This bill, S.1413, sponsored by Senator Gustavo Rivera, reduces the cap on cost-sharing for insulin from the current $100 per insulin per month to $30 per month.

•   Elderly Pharmaceutical Insurance Coverage Program Eligibility: This bill, S.2535A, sponsored by Senator Gustavo Rivera, sets the eligibility criteria for the Elderly Pharmaceutical Insurance Coverage Program. The bill specifies that participants must be enrolled in Medicare part D or any other public or private drug plan that successfully proves the coverage is similar to or better than the defined standards coverage under the Medicare Part D prescription drug benefit. 

•   Third-Party Payments For Co-Pays: This bill, S.5299A, sponsored by Senator Gustavo Rivera, requires 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 be applied 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.

•   Substitution Of Biosimilar Medications: This bill, S.8465, sponsored by Senator Gustavo Rivera, will make the existing temporary law a permanent law that allows pharmacists to substitute biosimilar medications under certain conditions.  

•   Sixty-Day Notice Drug Cost Increase: This bill, S.7499B, sponsored by Senator Julia Salazar, requires manufacturers to provide at least 60 days notice of their intent to raise wholesale prescription drug costs to the Department of Financial Services if the increase is 10% or more of the total cost of the drug.  

•   Wholesale Drug Importation: This bill, S.1737, sponsored by Senator James Skoufis, will create a state program to import prescription drugs from other countries at a lower cost. In this program, a wholesaler is allowed to import drugs that meet U.S. F.D.A. standards from only suppliers who are regulated and authorized under the laws of their country for distribution and sale only in New York.

•   Drug Failure Protocols: This bill, S.8191, sponsored by Senator Neil Breslin, requires a utilization review agent to follow certain rules when establishing a step therapy protocol. It requires that the protocol accepts any attestation submitted by the insured's health care professional stating that a required drug has failed as prima facie evidence that the required drug has failed.

•   Patient RX Information and Choice Expansion Act (PRICE Act): This bill, S.4620C, sponsored by Senator Neil Breslin, requires health plans to furnish in real-time cost, benefit, and coverage data to the enrollee, his or her health care provider, or the third-party of his or her choosing.

•   Thirty-Day Supply For State Disaster Emergencies: This bill, S.4856, sponsored by Senator Elijah Reichlin-Melnick, requires policies and contracts that provide coverage for prescription drugs to include coverage of an immediate additional thirty-day supply of a prescription drug during a state disaster emergency. 

•   Prescription Drugs From Out Of State: This bill, S.5489 sponsored by Senator Samra Brouk, authorizes pharmacies to receive prescription drugs from other pharmacies outside of New York in the case of a public health emergency, guaranteeing patient access to medications.

•   Price-Gouging For Medicine: This bill, S.3081A, sponsored by Senator Julia Salazar, prohibits selling a drug subject to a shortage for an unconscionably excessive price. The bill adds medicine to the list of goods and services that can be classified as possibly being subject to price gouging. The classification of medicines falling under this section of the law will be determined by the publicly reported drug shortages reported by the U.S. Food and Drug Administration. 

•   Prohibits the Application of Fail-First or Step Therapy Protocols: This bill, S.5909, sponsored by Senator Todd Kaminsky, prohibits the application of fail-first or step therapy protocols to coverage for the diagnosis and treatment of mental health conditions.