New York A 7142: Relates to requiring certain health insurance issuers to certify that at least a majority of prescription drug rebates are provided to patients at the point of sale

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A07142 Summary:

BILL NOA07142 

&nbsp

SAME ASSAME AS S02128

&nbsp

SPONSORWalker

&nbsp

COSPNSRDilan, Tapia, Alvarez, Reyes, Hyndman, Septimo, De Los Santos, Zaccaro, Jackson, Santabarbara,
 Taylor, Rivera, Cruz, Wieder, Bichotte Hermelyn

&nbsp

MLTSPNSR

&nbsp

Add §§3246 & 4331, Ins L; add §4417, Pub Health L

&nbsp

Requires certain health insurance issuers to certify that at least a majority of prescription drug rebates are provided to patients at the point of sale.

Go to top A07142 Actions:

BILL NOA07142 

&nbsp

03/20/2025referred to insurance

01/07/2026referred to insurance

Go to topA07142 Committee&nbspVotes:

Go to topA07142 Floor&nbspVotes:

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

Go to topA07142 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 7142

 2025-2026 Regular Sessions

 IN ASSEMBLY

 March 20, 2025
 ___________

 Introduced by M. of A. WALKER, DILAN, TAPIA, ALVAREZ, REYES, HYNDMAN,
 SEPTIMO, DE LOS SANTOS, ZACCARO, JACKSON, SANTABARBARA, TAYLOR,
 RIVERA, CRUZ -- read once and referred to the Committee on Insurance

 AN ACT to amend the insurance law and the public health law, in relation
 to requiring certain health insurance issuers to certify that at least
 a majority of prescription drug rebates are provided to patients at
 the point of sale

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

 1 Section 1. The insurance law is amended by adding a new section 3246
 2 to read as follows:
 3 § 3246. Ensuring fairness in certain cost sharing. (a) As used in this
 4 section, the following terms shall have the following meanings:
 5 (1) "Defined cost sharing" means a deductible payment or coinsurance
 6 amount imposed on an enrollee for a covered prescription drug under the
 7 enrollee's health plan.
 8 (2) "Insurer" means any health insurance issuer that is subject to
 9 state law regulating insurance and offers health insurance coverage, as
 10 defined in 42 U.S.C. § 300gg-91, or any state or local governmental
 11 employer plan.
 12 (3) "Price protection rebate" means a negotiated price concession that
 13 accrues directly or indirectly to the insurer, or other party on behalf
 14 of the insurer, in the event of an increase in the wholesale acquisition
 15 cost of a drug above a specified threshold.
 16 (4) "Rebate" means:
 17 (A) Negotiated price concessions including but not limited to base
 18 price concessions, whether described as a rebate or otherwise, and
 19 reasonable estimates of any price protection rebates and performance-
 20 based price concessions that may accrue directly or indirectly to the
 21 insurer during the coverage year from a manufacturer, dispensing pharma-

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD05948-01-5

 A. 7142 2

 1 cy, or other party in connection with the dispensing or administration
 2 of a prescription drug, and
 3 (B) Reasonable estimates of any negotiated price concessions, fees and
 4 other administrative costs that are passed through, or are reasonably
 5 anticipated to be passed through, to the insurer and serve to reduce the
 6 insurer's liabilities for a prescription drug.
 7 (b) An enrollee's defined cost sharing for each prescription drug
 8 shall be calculated at the point of sale based on a price that is
 9 reduced by an amount equal to at least eighty-five percent of all
 10 rebates received, or to be received, in connection with the dispensing
 11 or administration of the prescription drug. Nothing shall preclude an
 12 insurer from decreasing an enrollee's defined cost sharing by an amount
 13 greater than that required under this subsection.
 14 (c) An insurer shall submit to the superintendent by the first of
 15 January of each year a certification in a form to be established by the
 16 superintendent attesting that it has complied with the requirements of
 17 subsection (b) of this section for the prior calendar year.
 18 (d) In complying with the provisions of this section, an insurer or
 19 its agents shall not publish or otherwise publicly reveal information
 20 regarding the actual amount of rebates an insurer receives on a product
 21 or therapeutic class of products, m