N.Y. Insurance Law § 111-a: Notification of prescription drug price increases by manufacturers

§ 111-a. Notification of prescription drug price increases by

manufacturers. (a) This section shall apply to a manufacturer of a

prescription drug that is purchased or reimbursed in this state by any

of the following:

(1) An insurance company authorized in this state to write accident

and health insurance, a company organized pursuant to article

forty-three of this chapter, a municipal cooperative health benefit plan

established pursuant to article forty-seven of this chapter, an

organization certified pursuant to article forty-four of the public

health law, an institution of higher education certified pursuant to

section one thousand one hundred twenty-four of this chapter, or the New

York state health insurance plan established pursuant to article eleven

of the civil service law; or

(2) A pharmacy benefit manager, including an entity that directly or

through an intermediary, manages the prescription drug coverage provided

by a health insurer under a contract or policy delivered or issued for

delivery in this state or a health plan subject to section three hundred

sixty-four-j of the social services law, including the processing and

payment of claims for prescription drugs, the performance of drug

utilization review, the processing of drug prior authorization requests,

the adjudication of appeals or grievances related to prescription drug

coverage, contracting with network pharmacies, and controlling the cost

of covered prescription drugs.

(b) (1) A manufacturer of a prescription drug with a wholesale

acquisition cost of more than forty dollars for a course of therapy

shall notify the superintendent, his or her deputy or other officer

designated by the superintendent, if the increase in the wholesale

acquisition cost of such prescription drug is more than sixteen percent,

including the proposed increase and the cumulative increases that

occurred within the previous twenty-four months prior to the planned

effective date of the increase. For purposes of this section, a "course

of therapy" is defined as either of the following:

(i) the recommended daily dosage units of a prescription drug pursuant

to its prescribing label as approved by the federal Food and Drug

Administration for thirty days; or

(ii) the recommended daily dosage units of a prescription drug

pursuant to its prescribing label as approved by the federal Food and

Drug Administration for a normal course of treatment that is less than

thirty days.

(2) (i) The notice required by paragraph one of this subsection shall

be provided in writing to the superintendent at least sixty days prior

to the planned effective date of the increase and shall include the

proposed increase and the cumulative increases that occurred within the

previous twenty-four months.

(ii) The superintendent shall forthwith publish the notice required by

paragraph one of this subsection on the department of financial services

website within five days of its receipt.

(3) (i) The notice required by paragraph one of this subsection shall

include the date of the increase, the current wholesale acquisition cost

of the prescription drug, and the dollar amount of the future increase

in the wholesale acquisition cost of the prescription drug.

(ii) The notice required by paragraph one of this subsection shall

include a statement regarding whether a change or improvement in the

drug necessitates the price increase. If so, the manufacturer shall

describe the change or improvement.

(4) Information supplied by a manufacturer pursuant to this section

that the manufacturer has reasonably designated as a trade secret shall

be considered confidential and a trade secret, shall be exempt from

public disclosure and copying under article six of the public officers

law and shall not be disclosed directly or indirectly by the

superintendent. Notwithstanding the foregoing sentence, the

superintendent shall be permitted to disclose information in an

aggregated format if such aggregate information cannot directly or

indirectly be used to identify trade secret information related to a

specific manufacturer or the manufacturer's prescription drug, including

but not limited to any information related to pricing for the

manufacturer's prescription drug that has been reasonably designated as

a trade secret.

(5) In the event that a manufacturer of a prescription drug subject to

this section does not report the information required in paragraph one

of this subsection, the superintendent is authorized to impose any

penalty or remedy authorized by this chapter, after notice and a

hearing, against such manufacturer of up to five thousand dollars per

day for every day after the reporting period described in this section

that the required information is not reported.