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
              

 A. 8136                             2
 
 ADDITIONAL  INFORMATION,  INCLUDING  DETAILS  REGARDING  THE   INSURED'S
 REDUCED COST-SHARING.
   §  2.  Paragraph 16 of subsection (a) of section 3221 of the insurance
 law, as added by chapter 536 of the laws of 2010, is amended to read  as
 follows:
   (16)  (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
 ADDITIONAL   INFORMATION,  INCLUDING  DETAILS  REGARDING  THE  INSURED'S
 REDUCED COST-SHARING.
   § 3. Subsection (jj) of section 4303 of the insurance law, as added by
 chapter 536 of the laws of 2010 and as relettered by section 55 of  part
 D of chapter 56 of the laws of 2013, is amended to read as follows:
   (jj)  (1) No medical expense indemnity corporation, a hospital service
 corporation or a health service corporation which provides coverage  for
 prescription  drugs  and for which cost-sharing, deductibles or co-insu-
 rance obligations are determined by category of prescription drugs shall
 impose cost-sharing, deductibles or  co-insurance  obligations  for  any
 prescription drug that exceeds the dollar amount of cost-sharing, deduc-
 tibles  or co-insurance obligations for non-preferred brand drugs or its
 equivalent (or brand drugs if there is no non-preferred brand drug cate-
 gory).
   (2) NOTWITHSTANDING THE LIMITATIONS PRESCRIBED  IN  PARAGRAPH  ONE  OF
 THIS  SUBSECTION OR ANY OTHER PROVISION OF LAW, A MEDICAL EXPENSE INDEM-
 NITY CORPORATION, A HOSPITAL SERVICE CORPORATION  OR  A  HEALTH  SERVICE
 CORPORATION  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 PARAGRAPH 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  ADDITIONAL INFORMATION, INCLUDING DETAILS
 REGARDING THE INSURED'S REDUCED COST-SHARING.
   § 4. Subdivision 7 of section 4406-c of  the  public  health  law,  as
 added by chapter 536 of the laws of 2010, is amended to read as follows:
 A. 8136                             3
 
   7.  (A) No health maintenance organization which provides coverage for
 prescription drugs and for which cost-sharing, deductibles  or  co-insu-
 rance obligations are determined by category of prescription drugs shall
 impose  cost-sharing,  deductibles  or  co-insurance obligations for any
 prescription drug that exceeds the dollar amount of cost-sharing, deduc-
 tibles  or co-insurance obligations for non-preferred brand drugs or its
 equivalent (or brand drugs if there is no non-preferred brand drug cate-
 gory).
   (B) NOTWITHSTANDING THE LIMITATIONS PRESCRIBED  IN  PARAGRAPH  (A)  OF
 THIS  SUBDIVISION  OR  ANY  OTHER PROVISION OF LAW, A HEALTH MAINTENANCE
 ORGANIZATION WHICH PROVIDES COVERAGE FOR PRESCRIPTION DRUGS WHERE  COST-
 SHARING OBLIGATIONS ARE DETERMINED BY CATEGORY OF PRESCRIPTION DRUGS MAY
 OFFER A PROGRAM TO ENROLLEES THAT UTILIZES REBATES OR DISCOUNTS TO LOWER
 AN  ENROLLEE'S  COST-SHARING  FOR  PRESCRIPTION  DRUGS IF THE ENROLLEE'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 PARAGRAPH SHALL NOT BE DEEMED  A  SEPA-
 RATE  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 ENROLLEES TO A WEBSITE FOR ADDITIONAL  INFORMATION,  INCLUDING
 DETAILS REGARDING THE ENROLLEE'S REDUCED COST-SHARING.
   §  5.  This  act  shall take effect January 1, 2026 and shall apply to
 policies or contracts issued, renewed, modified, altered or  amended  on
 or after such date.