S T A T E O F N E W Y O R K
________________________________________________________________________
9662
I N A S S E M B L Y
March 27, 2024
___________
Introduced by M. of A. WEPRIN -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law and the social services law, in
relation to capping cost sharing for antiviral COVID-19 therapeutics
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subsection (i) of section 3216 of the insurance law is
amended by adding a new paragraph 39 to read as follows:
(39) (A) EVERY POLICY THAT PROVIDES COVERAGE FOR HOSPITAL, SURGICAL OR
MEDICAL CARE OR PRESCRIPTION DRUGS SHALL PROVIDE COVERAGE FOR ANTIVIRAL
THERAPEUTICS APPROVED OR GRANTED EMERGENCY USE AUTHORIZATION BY THE FOOD
AND DRUG ADMINISTRATION FOR THE TREATMENT OF COVID-19 WHEN PRESCRIBED OR
FURNISHED BY A LICENSED HEALTH CARE PROVIDER ACTING WITHIN THEIR SCOPE
OF PRACTICE AND THE STANDARD OF CARE.
(B) THE COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS PARA-
GRAPH SHALL NOT BE SUBJECT TO ANNUAL DEDUCTIBLES OR COINSURANCE,
PROVIDED, HOWEVER, THAT AN INSURED WHO IS ELIGIBLE FOR AND ABLE TO
OBTAIN FREE PRESCRIBED ANTIVIRAL THERAPEUTICS UNDER A MANUFACTURER OR
GOVERNMENT PROGRAM MAY BE REQUIRED TO USE SUCH PROGRAM BEFORE USING
COVERAGE REQUIRED PURSUANT TO THIS PARAGRAPH.
§ 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 23 to read as follows:
(23) (A) EVERY POLICY THAT PROVIDES COVERAGE FOR HOSPITAL, SURGICAL OR
MEDICAL CARE OR PRESCRIPTION DRUGS SHALL PROVIDE COVERAGE FOR ANTIVIRAL
THERAPEUTICS APPROVED OR GRANTED EMERGENCY USE AUTHORIZATION BY THE FOOD
AND DRUG ADMINISTRATION FOR THE TREATMENT OF COVID-19 WHEN PRESCRIBED OR
FURNISHED BY A LICENSED HEALTH CARE PROVIDER ACTING WITHIN THEIR SCOPE
OF PRACTICE AND THE STANDARD OF CARE.
(B) THE COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS PARA-
GRAPH SHALL NOT BE SUBJECT TO ANNUAL DEDUCTIBLES OR COINSURANCE,
PROVIDED, HOWEVER, THAT AN INSURED WHO IS ELIGIBLE FOR AND ABLE TO
OBTAIN FREE PRESCRIBED ANTIVIRAL THERAPEUTICS UNDER A MANUFACTURER OR
GOVERNMENT PROGRAM MAY BE REQUIRED TO USE SUCH PROGRAM BEFORE USING
COVERAGE REQUIRED PURSUANT TO THIS PARAGRAPH.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD14144-03-4
A. 9662 2
§ 3. Section 4303 of the insurance law is amended by adding a new
subsection (vv) to read as follows:
(VV) (1) EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPO-
RATION, A HOSPITAL SERVICE CORPORATION OR A HEALTH SERVICE CORPORATION
FOR DELIVERY IN THIS STATE THAT PROVIDES MEDICAL, HOSPITAL, SURGICAL
CARE, OR MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE AND
PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL PROVIDE COVERAGE FOR
ANTIVIRAL THERAPEUTICS APPROVED OR GRANTED EMERGENCY USE AUTHORIZATION
BY THE FOOD AND DRUG ADMINISTRATION FOR THE TREATMENT OF COVID-19 WHEN
PRESCRIBED OR FURNISHED BY A LICENSED HEALTH CARE PROVIDER ACTING WITHIN
THEIR SCOPE OF PRACTICE AND THE STANDARD OF CARE.
(2) SUCH COVERAGE REQUIRED PURSUANT TO PARAGRAPH ONE OF THIS
SUBSECTION SHALL NOT BE SUBJECT TO ANNUAL DEDUCTIBLES OR COINSURANCE,
PROVIDED, HOWEVER, THAT AN INSURED WHO IS ELIGIBLE FOR AND ABLE TO
OBTAIN FREE PRESCRIBED ANTIVIRAL THERAPEUTICS UNDER A MANUFACTURER OR
GOVERNMENT PROGRAM MAY BE REQUIRED TO USE SUCH PROGRAM BEFORE USING
COVERAGE REQUIRED PURSUANT TO THIS PARAGRAPH.
§ 4. Subdivision 2 of section 365-a of the social services law is
amended by adding a new paragraph (nn) to read as follows:
(NN) (I) ANTIVIRAL THERAPEUTICS APPROVED OR GRANTED EMERGENCY USE
AUTHORIZATION BY THE FOOD AND DRUG ADMINISTRATION FOR THE TREATMENT OF
COVID-19 WHEN PRESCRIBED OR FURNISHED BY A LICENSED HEALTH CARE PROVIDER
ACTING WITHIN THEIR SCOPE OF PRACTICE AND THE STANDARD OF CARE.
(II) COVERAGE REQUIRED PURSUANT TO THIS PARAGRAPH SHALL BE PROVIDED AT
NO COST TO THE INSURED, PROVIDED, HOWEVER, THAT AN INSURED WHO IS ELIGI-
BLE FOR AND ABLE TO OBTAIN FREE PRESCRIBED ANTIVIRAL THERAPEUTICS UNDER
A MANUFACTURER OR GOVERNMENT PROGRAM MAY BE REQUIRED TO USE SUCH PROGRAM
BEFORE USING COVERAGE REQUIRED PURSUANT TO THIS PARAGRAPH.
§ 5. This act shall take effect immediately and shall apply to any
policy or contract issued, renewed, modified, altered, or amended on or
after January 1, 2025.