New York A 6278: Relates to electronic notification when prior authorization is required to fill a prescription

Bill Text

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A06278 Summary:

BILL NOA06278 

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SAME ASNo Same As

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SPONSORSteck

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COSPNSRSeawright

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MLTSPNSR

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Amd §§3217-a & 4324, Ins L; amd §4408, Pub Health L

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Requires insurers to provide electronic notification when prior authorization is required to fill a prescription if requested by the insured.

Go to top A06278 Actions:

BILL NOA06278 

&nbsp

03/03/2025referred to insurance

01/07/2026referred to insurance

01/15/2026enacting clause stricken

Go to topA06278 Committee&nbspVotes:

Go to topA06278 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topA06278 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 6278

 2025-2026 Regular Sessions

 IN ASSEMBLY

 March 3, 2025
 ___________

 Introduced by M. of A. STECK, SEAWRIGHT -- read once and referred to the
 Committee on Insurance

 AN ACT to amend the insurance law and the public health law, in relation
 to electronic notification when prior authorization is required to
 fill a prescription

 The People of the State of New York, represented in Senate and Assem-
 bly, do enact as follows:

 1 Section 1. Paragraphs 13 and 14 of subsection (b) of section 3217-a of
 2 the insurance law, as added by section 2 of part H of chapter 60 of the
 3 laws of 2014, are amended and a new paragraph 15 is added to read as
 4 follows:
 5 (13) disclose whether a health care provider scheduled to provide a
 6 health care service is an in-network provider; [and]
 7 (14) with respect to out-of-network coverage, disclose the approximate
 8 dollar amount that the insurer will pay for a specific out-of-network
 9 health care service. The insurer shall also inform the insured through
 10 such disclosure that such approximation is not binding on the insurer
 11 and that the approximate dollar amount that the insurer will pay for a
 12 specific out-of-network health care service may change[.]; and
 13 (15) where applicable, allow an insured to request an electronic
 14 notification within thirty days when prior authorization is required to
 15 fill a prescription.
 16 § 2. Paragraphs 13 and 14 of subsection (b) of section 4324 of the
 17 insurance law, as added by section 9 of part H of chapter 60 of the laws
 18 of 2014, are amended and a new paragraph 15 is added to read as follows:
 19 (13) disclose whether a health care provider scheduled to provide a
 20 health care service is an in-network provider; [and]
 21 (14) with respect to out-of-network coverage, disclose the approximate
 22 dollar amount that the corporation will pay for a specific out-of-net-
 23 work health care service. The corporation shall also inform the insured
 24 through such disclosure that such approximation is not binding on the

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD10368-01-5

 A. 6278 2

 1 corporation and that the approximate dollar amount that the corporation
 2 will pay for a specific out-of-network health care service may
 3 change[.]; and
 4 (15) where applicable, allow an insured to request an electronic
 5 notification within thirty days when prior authorization is required to
 6 fill a prescription.
 7 § 3. Paragraphs (m) and (n) of subdivision 2 of section 4408 of the
 8 public health law, as added by section 19 of part H of chapter 60 of the
 9 laws of 2014, are amended and a new paragraph (o) is added to read as
 10 follows:
 11 (m) disclose whether a health care provider scheduled to provide a
 12 health care service is an in-network provider; [and]
 13 (n) with respect to out-of-network coverage, disclose the approximate
 14 dollar amount that the health maintenance organization will pay for a
 15 specific out-of-network health care service. The health maintenance
 16 organization shall also inform an enrollee through such disclosure that
 17 such approximation is not binding on the health maintenance organization
 18 and that the approximate dollar amount that the health maintenance
 19 organization will pay for a specific out-of-network health care service
 20 may change[.]; and
 21 (o) where applicable, allow an insured to request an electronic
 22 notification within thirty days when prior authorization is required to
 23 fill a prescripti