The New York State Senate Insurance Committee convened today, the first day back at work for lawmakers following a two-week break. Committee members voted on a handful of bills, but there were two pieces of legislation that we are keeping an eye on.
S.2849 – Prohibiting Mid-Year Formulary Changes
The legislation would prohibit a health care plan from making prescription drug formulary changes during a contract year. Sponsored by Senator Neil Breslin (D – Albany), the purpose of the bill is “to ensure that health insurance enrollees have assurance that their health plan will maintain continuity in coverage for their prescription drugs during the course of the enrollment year.” However, by preventing a health plan from removing a prescription drug from its formulary or revising the clinical criteria for the use of such drugs, the bill would inhibit a health plan’s ability to ensure that our members are afforded the most cost effective and highest quality drugs when available, especially as new emerging drugs are introduced. Prescription drug costs are the fastest growing component of health care costs so that flexibility is critical.
S.3852 – Coverage of Mammograms at Age 35
Known as “Shannon’s Law,” the legislation would require insurance companies to cover annual mammograms for breast cancer screening for members who are 35 and older. Sponsored by Senator Monica Martinez, (D – Long Island), the purpose of the bill is “to increase access to annual breast exams for New Yorkers aged 35 to 39.” One major problem with this bill is that it imposes a mandate which is not supported by national guidelines. It would increase the risk for over-diagnosis and subsequent overtreatment, causing more harm than good to the those individuals the legislation aims to benefit. The bill also extends health insurance coverage outside the scope of covered preventative services within the Essential Health Benefits of the Affordable Care Act, which would impose a costly mandate, funded by taxpayer dollars.