S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3833
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 30, 2025
                                ___________
 
 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 40 to read as follows:
   (40) (A) EVERY POLICY THAT 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 BY A LICENSED HEALTH CARE PROVIDER
 LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW.
   (B)  COVERAGE  UNDER  THIS  PARAGRAPH  SHALL  NOT BE SUBJECT TO ANNUAL
 DEDUCTIBLES OR COINSURANCE, PROVIDED, HOWEVER, THAT AN  INSURED  WHO  IS
 ELIGIBLE  FOR AND ABLE TO OBTAIN PRESCRIBED ANTIVIRAL THERAPEUTICS AT NO
 COST OR REDUCED COST 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 24 to read as follows:
   (24) (A) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR  DELIV-
 ERY  IN  THIS  STATE THAT PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL
 PROVIDE COVERAGE FOR ANTIVIRAL THERAPEUTICS APPROVED OR GRANTED EMERGEN-
 CY USE AUTHORIZATION BY THE FOOD AND DRUG ADMINISTRATION FOR THE  TREAT-
 MENT  OF  COVID-19  WHEN  PRESCRIBED  BY A LICENSED HEALTH CARE PROVIDER
 LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW.
   (B) COVERAGE UNDER THIS PARAGRAPH  SHALL  NOT  BE  SUBJECT  TO  ANNUAL
 DEDUCTIBLES  OR  COINSURANCE,  PROVIDED, HOWEVER, THAT AN INSURED WHO IS
 ELIGIBLE FOR AND ABLE TO OBTAIN PRESCRIBED ANTIVIRAL THERAPEUTICS AT  NO
 COST  OR  REDUCED COST UNDER A MANUFACTURER OR GOVERNMENT PROGRAM MAY BE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07443-01-5
              

 A. 3833                             2
 
 REQUIRED TO USE SUCH PROGRAM BEFORE USING COVERAGE REQUIRED PURSUANT  TO
 THIS PARAGRAPH.
   §  3.  Section  4303  of  the insurance law is amended by adding a new
 subsection (ww) to read as follows:
   (WW) (1) EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE  INDEMNITY  CORPO-
 RATION,  A HOSPITAL SERVICE CORPORATION, OR A HEALTH SERVICE CORPORATION
 THAT 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 BY A LICENSED HEALTH  CARE  PROVIDER  LEGALLY  AUTHORIZED  TO
 PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW.
   (2)  COVERAGE  UNDER  THIS  SUBSECTION  SHALL NOT BE SUBJECT TO ANNUAL
 DEDUCTIBLES OR COINSURANCE, PROVIDED, HOWEVER, THAT AN  INSURED  WHO  IS
 ELIGIBLE  FOR AND ABLE TO OBTAIN PRESCRIBED ANTIVIRAL THERAPEUTICS AT NO
 COST OR REDUCED COST UNDER A MANUFACTURER OR GOVERNMENT PROGRAM  MAY  BE
 REQUIRED  TO USE SUCH PROGRAM BEFORE USING COVERAGE REQUIRED PURSUANT TO
 THIS SUBSECTION.
   § 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  BY  A  LICENSED HEALTH CARE PROVIDER LEGALLY
 AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW.
   (II) COVERAGE UNDER THIS PARAGRAPH SHALL BE PROVIDED AT NO COST TO THE
 INSURED, PROVIDED, HOWEVER, THAT AN INSURED WHO IS ELIGIBLE FOR AND ABLE
 TO OBTAIN PRESCRIBED ANTIVIRAL THERAPEUTICS AT NO COST OR  REDUCED  COST
 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 on  the  first  day  of  January  next
 succeeding  the date on which it shall have become a law and shall apply
 to all policies and contracts issued,  renewed,  modified,  altered,  or
 amended on or after such date.