New York A 1287: Relates to coverage for single source drugs

Bill Text

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A01287 Summary:

BILL NOA01287 

&nbsp

SAME ASSAME AS S06168

&nbsp

SPONSORRamos

&nbsp

COSPNSRSantabarbara

&nbsp

MLTSPNSR

&nbsp

Amd §§3216, 3221 & 4303, Ins L

&nbsp

Provides that every insurance policy which provides coverage for prescription drugs shall insure that there is continuous coverage of a single source drug that is part of a prescribed therapy until such prescribed therapy is no longer medically necessary for the enrollee of such policy; defines "single source drug".

Go to top A01287 Actions:

BILL NOA01287 

&nbsp

01/09/2025referred to insurance

01/07/2026referred to insurance

Go to topA01287 Committee&nbspVotes:

Go to topA01287 Floor&nbspVotes:

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

Go to topA01287 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 1287

 2025-2026 Regular Sessions

 IN ASSEMBLY

 January 9, 2025
 ___________

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

 AN ACT to amend the insurance law, in relation to coverage for single
 source drugs

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

 1 Section 1. Subsection (i) of section 3216 of the insurance law is
 2 amended by adding a new paragraph 40 to read as follows:
 3 (40) Every individual or blanket policy delivered or issued for deliv-
 4 ery in this state providing coverage for prescription drugs through the
 5 use of a drug formulary shall include a provision which, in the event of
 6 a change to such formulary, allows a covered person who is taking a
 7 single source drug covered under such policy that is no longer included
 8 in or preferred under such formulary and has filed a grievance or an
 9 appeal of the denial of access to the drug with the insurer or a state
 10 or federal agency or designee of such agency, to continue receiving
 11 coverage for such drug under the same terms and conditions as would
 12 apply under the policy were such drug still included in or preferred
 13 under the formulary, until a final decision is rendered on the appeal or
 14 grievance. For the purpose of this paragraph, "single source drug" means
 15 a brandname drug for which there is no generic equivalent.
 16 § 2. Subsection (k) of section 3221 of the insurance law is amended by
 17 adding a new paragraph 24 to read as follows:
 18 (24) Every group or blanket policy delivered or issued for delivery in
 19 this state providing coverage for prescription drugs through the use of
 20 a drug formulary shall include a provision which, in the event of a
 21 change to such formulary, allows a covered person who is taking a single
 22 source drug covered under such policy that is no longer included in or
 23 preferred under such formulary and has filed a grievance or an appeal of
 24 the denial of access to the drug with the insurer or a state or federal
 25 agency or designee of such agency, to continue receiving coverage for

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD02413-01-5

 A. 1287 2

 1 such drug under the same terms and conditions as would apply under the
 2 policy were such drug still included in or preferred under the formu-
 3 lary, until a final decision is rendered on the appeal or grievance. For
 4 the purpose of this paragraph, "single source drug" means a brandname
 5 drug for which there is no generic equivalent.
 6 § 3. Section 4303 of the insurance law is amended by adding a new
 7 subsection (ww) to read as follows:
 8 (ww) Every contract delivered or issued for delivery in this state
 9 providing coverage for prescription drugs through the use of a drug
 10 formulary shall include a provision which, in the event of a change to
 11 such formulary, allows a covered person who is taking a single source
 12 drug covered under such contract that is no longer included in or
 13 preferred under such formulary and has filed a grievance or an appeal of
 14 the denial of access to the drug with the insurer corporation or organ-
 15 ization certified pursuant to article forty-four of the public health
 16 law or a state or federal agency or designee of such agency, to continue
 17 receiving coverage for such drug under the same terms