Authorizes insurance policies which provide coverage for prescription drugs where cost-sharing obligations are determined by category of prescription drugs to offer a program to insureds that utilizes rebates or discounts to lower an insured's cost-sharing for prescription drugs if the insured's cost-sharing under such program would be more favorable than the cost-sharing that would otherwise be applicable to the prescription drug.
S T A T E O F N E W Y O R K
________________________________________________________________________
8136
2025-2026 Regular Sessions
I N A S S E M B L Y
May 1, 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 public health law, in relation
to authorizing insurance policies which provide coverage for
prescription drugs and involve cost-sharing obligations to offer a
program to insureds utilizing rebates or discounts
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 27 of subsection (i) of section 3216 of the
insurance law, as added by chapter 536 of the laws of 2010, is amended
to read as follows:
(27) (A) No policy delivered or issued for delivery in this state
which provides coverage for prescription drugs and for which cost-shar-
ing, deductibles or co-insurance obligations are determined by category
of prescription drugs shall impose cost-sharing, deductibles or co-insu-
rance obligations for any prescription drug that exceeds the dollar
amount of cost-sharing, deductibles or co-insurance obligations for
non-preferred brand drugs or its equivalent (or brand drugs if there is
no non-preferred brand drug category).
(B) NOTWITHSTANDING THE LIMITATIONS PRESCRIBED IN SUBPARAGRAPH (A) OF
THIS PARAGRAPH OR ANY OTHER PROVISION OF LAW, A POLICY DELIVERED OR
ISSUED FOR DELIVERY IN THIS STATE WHICH PROVIDES COVERAGE FOR
PRESCRIPTION DRUGS WHERE COST-SHARING OBLIGATIONS ARE DETERMINED BY
CATEGORY OF PRESCRIPTION DRUGS MAY OFFER A PROGRAM TO INSUREDS THAT
UTILIZES REBATES OR DISCOUNTS TO LOWER AN INSURED'S COST-SHARING FOR
PRESCRIPTION DRUGS IF THE INSURED'S COST-SHARING UNDER SUCH PROGRAM
WOULD BE MORE FAVORABLE THAN THE COST-SHARING THAT WOULD OTHERWISE BE
APPLICABLE TO THE PRESCRIPTION DRUG. A PROGRAM OFFERED PURSUANT TO THIS
SUBPARAGRAPH SHALL NOT BE DEEMED A SEPARATE TIER OF DRUG COST-SHARING. A
DESCRIPTION OF THE PROGRAM SHALL BE SET FORTH IN THE POLICY OR CONTRACT,
PROVIDED, HOWEVER, SUCH DESCRIPTION MAY REFER INSUREDS TO A WEBSITE FOR
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11644-01-5
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