New York A 11256: Requires health plan coverage to include certain generic drugs and biosimilars

Bill Text

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A11256 Summary:

BILL NOA11256 

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SAME ASNo Same As

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SPONSORJensen

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COSPNSR

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MLTSPNSR

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Amd §§3242 & 4329, Ins L

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Requires health plan coverage to include generic drugs and biosimilars where the wholesale acquisition cost of such generic drugs or biosimilars is lower than the brand drug's wholesale acquisition cost.

Go to top A11256 Actions:

BILL NOA11256 

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05/04/2026referred to insurance

Go to topA11256 Committee&nbspVotes:

Go to topA11256 Floor&nbspVotes:

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

Go to topA11256 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 11256

 IN ASSEMBLY

 May 4, 2026
 ___________

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

 AN ACT to amend the insurance law, in relation to requiring health plan
 coverage to include certain generic drugs and biosimilars

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

 1 Section 1. Section 3242 of the insurance law is amended by adding a
 2 new subsection (d) to read as follows:
 3 (d) (1) For the purposes of this subsection, the following terms shall
 4 have the following meanings:
 5 (A) "Biosimilar" means any biological product that is licensed under
 6 42 U.S.C.§ 262(k) and has been listed in the FDA's database of licensed
 7 biological products, commonly referred to as the purple book, as biosi-
 8 milar to or interchangeable with a reference biological product.
 9 (B) "Brand drug" means a drug for which an application has been
 10 approved under 21 U.S.C. § 355(c), or a biological product, other than a
 11 biosimilar, that is licensed under 42 U.S.C. § 262(a).
 12 (C) "FDA" means the U.S. Food and Drug Administration.
 13 (D) "Formulary" means a list of prescription drugs that is developed
 14 by a pharmacy and therapeutics committee or other clinical and pharmacy
 15 experts and represents a policy's prescription drugs approved for use.
 16 (E) "Generic drug" means a drug for which an application has been
 17 approved under 21 U.S.C. §355(j) and which has been listed in the FDA's
 18 approved drug products with therapeutic equivalence evaluations, common-
 19 ly referred to as the orange book, as therapeutically equivalent to a
 20 reference drug, even if the manufacturer of such drug applies a trade
 21 name to the drug.
 22 (F) "Policy" means a policy delivered or issued for delivery in this
 23 state that provides coverage for prescription drugs.
 24 (G) "Reference listed drug" is the listed drug identified by the FDA
 25 as the drug product upon which an applicant relies in seeking approval
 26 of its application submitted under 21 U.S.C. §355(j).
 27 (H) "Reference product" is a single biological product, licensed by
 28 the FDA under 42 U.S.C. § 262(a), against which a proposed biosimilar or

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD14739-01-6

 A. 11256 2

 1 interchangeable product is compared, and listed as a reference product
 2 in the FDA's database of licensed biological products, commonly referred
 3 to as the purple book.
 4 (I) "Wholesale acquisition cost" has the same meaning as defined by 42
 5 U.S.C. § 1395w-3a(c)(6)(B).
 6 (2) (A) If a generic drug is approved by the FDA, is marketed pursuant
 7 to such approval, and has a wholesale acquisition cost that is less than
 8 the wholesale acquisition cost of the reference listed drug on such
 9 generic drug's initial date of marketing, then policies that provide
 10 coverage for such generic drug's reference listed drug at the time of
 11 such generic drug's marketing date shall:
 12 (i) immediately make such generic drug available on the formulary with
 13 more favorable cost sharing, including actual out-of-pocket costs, rela-
 14 tive to such reference listed drug; and
 15 (ii) not impose any prior authorization, step therapy, or other limi-
 16 tation on coverage of a generic drug for which formulary placement is
 17 required under clause (i) of this subparagraph, nor impose any
 18 restriction on a pharmacy through which an enrollee may obtain such
 19 generic drug, that makes it more difficult for an enrollee to obtain
 20 covera