Assembly Bill A5354

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5354
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 13, 2025
                                ___________
 
 Introduced  by M. of A. STECK -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance  law,  in  relation  to  requiring  health
   insurers  to  provide  coverage without cost-sharing for opioid antag-
   onists and devices
 
   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) (I) EVERY POLICY WHICH  PROVIDES  COVERAGE  FOR  PRESCRIPTION
 DRUGS  SHALL  INCLUDE  COVERAGE  FOR  AT LEAST ONE OPIOID ANTAGONIST AND
 DEVICE.  NO PRIOR AUTHORIZATION OR PREMEDICAL REVIEW FOR COVERAGE OF  AN
 OPIOID ANTAGONIST IS REQUIRED.
   (II)  AS USED IN THIS PARAGRAPH "OPIOID ANTAGONIST AND DEVICE" MEANS A
 DRUG APPROVED BY THE FOOD AND DRUG ADMINISTRATION  THAT,  WHEN  ADMINIS-
 TERED,  NEGATES  OR  NEUTRALIZES IN WHOLE OR IN PART THE PHARMACOLOGICAL
 EFFECTS OF AN OPIOID IN THE BODY. "OPIOID ANTAGONIST" SHALL  BE  LIMITED
 TO MEDICATIONS APPROVED BY THE DEPARTMENT OF HEALTH FOR SUCH PURPOSE.
   (B)  THE  COVERAGE  MANDATED  BY  THIS  PARAGRAPH SHALL INCLUDE OPIOID
 ANTAGONISTS PRESCRIBED OR DISPENSED VIA STANDING ORDER OR  COLLABORATIVE
 PRACTICE AGREEMENT INTENDED FOR USE ON PATIENTS OTHER THAN THE INSURED.
   (C)  A POLICY SHALL NOT IMPOSE A DEDUCTIBLE, CO-INSURANCE, CO-PAYMENT,
 OR ANY OTHER COST-SHARING REQUIREMENT ON SUCH COVERAGE PROVIDED PURSUANT
 TO THIS PARAGRAPH.
   § 2. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 7-c to read as follows:
   (7-C) (A) (I) EVERY POLICY WHICH PROVIDES  COVERAGE  FOR  PRESCRIPTION
 DRUGS  SHALL  INCLUDE  COVERAGE  FOR  AT LEAST ONE OPIOID ANTAGONIST AND
 DEVICE.  NO PRIOR AUTHORIZATION OR PREMEDICAL REVIEW FOR COVERAGE OF  AN
 OPIOID ANTAGONIST IS REQUIRED.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07388-02-5
 A. 5354                             2
              

 
   (II)  AS USED IN THIS PARAGRAPH "OPIOID ANTAGONIST AND DEVICE" MEANS A
 DRUG APPROVED BY THE FOOD AND DRUG ADMINISTRATION  THAT,  WHEN  ADMINIS-
 TERED,  NEGATES  OR  NEUTRALIZES IN WHOLE OR IN PART THE PHARMACOLOGICAL
 EFFECTS OF AN OPIOID IN THE BODY. "OPIOID ANTAGONIST" SHALL  BE  LIMITED
 TO MEDICATIONS APPROVED BY THE DEPARTMENT OF HEALTH FOR SUCH PURPOSE.
   (B)  THE  COVERAGE  MANDATED  BY  THIS  PARAGRAPH SHALL INCLUDE OPIOID
 ANTAGONISTS PRESCRIBED OR DISPENSED VIA STANDING ORDER OR  COLLABORATIVE
 PRACTICE AGREEMENT INTENDED FOR USE ON PATIENTS OTHER THAN THE INSURED.
   (C)  A  GROUP  OR  BLANKET  POLICY SUBJECT TO THIS PARAGRAPH SHALL NOT
 IMPOSE A DEDUCTIBLE, CO-INSURANCE, CO-PAYMENT, OR ANY OTHER COST-SHARING
 REQUIREMENT ON SUCH COVERAGE PROVIDED 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) (A) EVERY POLICY THAT IS ISSUED, AMENDED, RENEWED, EFFECTIVE,
 OR  DELIVERED  ON  OR  AFTER  JANUARY FIRST, TWO THOUSAND TWENTY-SIX AND
 PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL INCLUDE COVERAGE  FOR  AT
 LEAST  ONE  OPIOID  ANTAGONIST  AND  DEVICE.   NO PRIOR AUTHORIZATION OR
 PREMEDICAL REVIEW FOR COVERAGE OF AN OPIOID ANTAGONIST IS REQUIRED.
   (B) AS USED IN THIS SUBSECTION "OPIOID ANTAGONIST AND DEVICE" MEANS  A
 DRUG  APPROVED  BY  THE FOOD AND DRUG ADMINISTRATION THAT, WHEN ADMINIS-
 TERED, NEGATES OR NEUTRALIZES IN WHOLE OR IN  PART  THE  PHARMACOLOGICAL
 EFFECTS  OF  AN OPIOID IN THE BODY. "OPIOID ANTAGONIST" SHALL BE LIMITED
 TO MEDICATIONS APPROVED BY THE DEPARTMENT OF HEALTH FOR SUCH PURPOSE.
   (2) A CONTRACT SUBJECT TO THIS SUBSECTION SHALL NOT IMPOSE  A  DEDUCT-
 IBLE,  COINSURANCE,  COPAYMENT, OR ANY OTHER COST-SHARING REQUIREMENT ON
 SUCH COVERAGE PROVIDED PURSUANT TO THIS SUBSECTION.
   § 4. This act shall take effect immediately and shall apply  to  poli-
 cies  and  contracts issued, renewed, modified, altered or amended on or
 after such effective date.