New York Legislative Updates
By David Eagle, M.D.
Like all legislatures, the New York legislature runs according to its own distinct rhythm. The Assembly and Senate are in session from January to early June. Any legislation that does not pass by the end of the session is done for the year. Any legislation that does pass has until the end of the calendar year to be signed or vetoed by the Governor. This usually leads to a flurry of activity in June and this year was no different.
As is typical, there was good news and bad news. Some of the good news was the passage of A.879 Gottfried/S.8299 Cleare. This legislation requires that “peer-to-peer” physicians be in the same specialty as the case that they are reviewing. The need for this may seem blindingly obvious to those of us on medicine’s frontlines. Who would go to a dermatologist for a second opinion for open-heart surgery? Nevertheless, the insurance companies have been escalating this bad prior authorization practice for years. This legislation is certainly a welcome change and we will be urging the Governor to sign it into law.
Unfortunately, the “Gold Card” prior authorization bill which would exempt doctors from prior authorization for a period of time if they have a greater than 90% track record of authorization did not make it. This legislation has been passed in Texas and is under consideration now in many other states. We hope that this valuable bill gets reintroduced next year and will do all that we can to support it. Also unfortunate was the passage of A.6770 Weinstein/S.74 Hoylman which expands the types of awardable damages in a wrongful death action. If signed by the Governor, this can be expected to increase New York’s already severely elevated medical liability premiums.
After a bill, passes, the hard work just begins. Last year, the New York legislature passed A.1396/S.3762, a broad and sweeping bill that regulates Pharmacy Benefit Managers (PBMs)on a state level. Provisions include the establishment of a PBM duty to covered individuals and providers and the need for PBMs to be licensed in the state of New York. Inappropriate PBM practices could result in the revocation of their license. Similar legislation was vetoed by the former Governor two years ago, and it was no guarantee that the current Governor would be willing to sign. New York Cancer & Blood Specialist had a call with Governor Hochul’s staff at the end of last year to encourage the signing of the bill. We subsequently had a law firm prepare a special report for the Governor’s office regarding legal challenges in other states to PBM regulations. We were thrilled that the Governor did sign the legislation leading to the establishment of the Pharmacy Benefits Bureau within the Department of Financial Services.
Just recently, we had a call with the leadership of the newly formed Pharmacy Benefits Bureau. They are now in the process of rule-making, and this will soon be available for public comment. We are impressed that the Bureau is planning adequate staffing for enforcement capabilities. It is important for oncology practices to understand this new entity. When PBMs demonstrate conduct that is harmful and unfair to patients and practices, this will be the place to go. The specific rules and regulations are now forthcoming, but it appears likely the state of New York will lead the nation in finally ending at least some abusive PBM practices.