Assembly Bill A1428

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1428
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 9, 2025
                                ___________
 
 Introduced  by M. of A. FORREST -- read once and referred to the Commit-
   tee on Insurance
 
 AN ACT to amend the insurance law, in  relation  to  substituting  brand
   name prescription drugs in the case of a drug shortage
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Section 3242 of the insurance law is amended  by  adding  a
 new subsection (d) to read as follows:
   (D) (1) AS USED IN THIS SUBSECTION:
   (A)  "ELIGIBLE  PRESCRIPTION  DRUG" MEANS A PRESCRIPTION DRUG APPROVED
 UNDER 21 U.S.C. 355(C) THAT IS NOT UNDER PATENT.
   (B) "GENERIC DRUG" MEANS A DRUG THAT IS APPROVED PURSUANT TO AN APPLI-
 CATION REFERENCING AN ELIGIBLE PRESCRIPTION DRUG THAT IS SUBMITTED UNDER
 SUBSECTION (J) OF SECTION 505 OF THE FEDERAL FOOD,  DRUG,  AND  COSMETIC
 ACT, 21 U.S.C. 355.
   (C)  "SUPPLY  ISSUE" MEANS A DRUG SHORTAGE OR MEANINGFUL DISRUPTION AS
 DEFINED IN 21 U.S.C. 356(C).
   (2) IN THE EVENT AN AB-RATED  GENERIC  EQUIVALENT  OR  INTERCHANGEABLE
 BIOLOGICAL  PRODUCT  FOR  AN ELIGIBLE PRESCRIPTION DRUG IS COVERED IN AN
 INSURER'S FORMULARY AND SUCH GENERIC DRUG EQUIVALENT IS UNAVAILABLE  DUE
 TO A SUPPLY ISSUE WHICH HAS BEEN RECOGNIZED BY THE FEDERAL FOOD AND DRUG
 ADMINISTRATION  PURSUANT  TO  21  U.S.C.  356E  AND THE DOSAGE CANNOT BE
 ADJUSTED, AN INSURER THAT DELIVERS OR ISSUES FOR DELIVERY IN THIS  STATE
 A  POLICY  THAT  PROVIDES  COVERAGE FOR PRESCRIPTION DRUGS SHALL PROVIDE
 COVERAGE FOR A BRAND NAME ELIGIBLE PRESCRIPTION DRUG TO AN  INSURED  WHO
 IS  ALREADY  RECEIVING SUCH PRESCRIPTION DRUG AS A GENERIC EQUIVALENT OR
 HAS BEEN DIAGNOSED WITH OR PRESENTED WITH A CONDITION ON OR PRIOR TO THE
 START OF THE PLAN YEAR THAT IS TREATED  BY  SUCH  ELIGIBLE  PRESCRIPTION
 DRUG OR IS AN ELIGIBLE PRESCRIPTION DRUG THAT IS OR WOULD BE PART OF THE
 INSURED'S TREATMENT REGIMEN FOR SUCH CONDITION. SUCH BRAND NAME ELIGIBLE
 PRESCRIPTION  DRUG SHALL BE COVERED AT THE SAME LEVEL OF COVERAGE AS THE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03949-01-5
              

 A. 1428                             2
 
 GENERIC DRUG IN THE INSURER'S FORMULARY UNTIL SUCH TIME  AS  THE  SUPPLY
 ISSUE  IS  RESOLVED  AND THE DRUG HAS BEEN REMOVED FROM THE FEDERAL FOOD
 AND DRUG ADMINISTRATION'S SHORTAGE LIST.
   §  2.  Section  4329  of  the insurance law is amended by adding a new
 subsection (d) to read as follows:
   (D) (1) AS USED IN THIS SUBSECTION:
   (A) "ELIGIBLE PRESCRIPTION DRUG" MEANS A  PRESCRIPTION  DRUG  APPROVED
 UNDER 21 U.S.C. 355(C) THAT IS NOT UNDER PATENT.
   (B) "GENERIC DRUG" MEANS A DRUG THAT IS APPROVED PURSUANT TO AN APPLI-
 CATION REFERENCING AN ELIGIBLE PRESCRIPTION DRUG THAT IS SUBMITTED UNDER
 SUBSECTION  (J)  OF  SECTION 505 OF THE FEDERAL FOOD, DRUG, AND COSMETIC
 ACT, 21 U.S.C. 355.
   (C) "SUPPLY ISSUE" MEANS A DRUG SHORTAGE OR MEANINGFUL  DISRUPTION  AS
 DEFINED IN 21 U.S.C. 356(C).
   (2)  IN  THE  EVENT  AN AB-RATED GENERIC EQUIVALENT OR INTERCHANGEABLE
 BIOLOGICAL PRODUCT FOR AN ELIGIBLE PRESCRIPTION DRUG IS  COVERED  IN  AN
 INSURER'S  FORMULARY AND SUCH GENERIC DRUG EQUIVALENT IS UNAVAILABLE DUE
 TO A SUPPLY ISSUE WHICH HAS BEEN RECOGNIZED BY THE FEDERAL FOOD AND DRUG
 ADMINISTRATION PURSUANT TO 21 U.S.C.  356E  AND  THE  DOSAGE  CANNOT  BE
 ADJUSTED,  A  CORPORATION SUBJECT TO THE PROVISIONS OF THIS ARTICLE THAT
 ISSUES A CONTRACT THAT PROVIDES COVERAGE FOR  PRESCRIPTION  DRUGS  SHALL
 PROVIDE  COVERAGE  FOR  A  BRAND  NAME  ELIGIBLE PRESCRIPTION DRUG TO AN
 INSURED WHO IS ALREADY RECEIVING SUCH PRESCRIPTION  DRUG  AS  A  GENERIC
 EQUIVALENT  OR  HAS BEEN DIAGNOSED WITH OR PRESENTED WITH A CONDITION ON
 OR PRIOR TO THE START OF THE PLAN YEAR THAT IS TREATED BY SUCH  ELIGIBLE
 PRESCRIPTION  DRUG  OR IS AN ELIGIBLE PRESCRIPTION DRUG THAT IS OR WOULD
 BE PART OF THE INSURED'S TREATMENT  REGIMEN  FOR  SUCH  CONDITION.  SUCH
 BRAND NAME ELIGIBLE PRESCRIPTION DRUG SHALL BE COVERED AT THE SAME LEVEL
 OF  COVERAGE  AS  THE GENERIC DRUG IN THE INSURER'S FORMULARY UNTIL SUCH
 TIME AS THE SUPPLY ISSUE IS RESOLVED AND THE DRUG HAS BEEN REMOVED  FROM
 THE FEDERAL FOOD AND DRUG ADMINISTRATION'S SHORTAGE LIST.
   § 3. This act shall take effect immediately.