S T A T E O F N E W Y O R K
________________________________________________________________________
9519
I N A S S E M B L Y
January 14, 2026
___________
Introduced by M. of A. McDONALD -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law, in relation to requiring certain
health insurance policies include coverage services provided by phar-
macists related to contraceptives
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Item (v) of subparagraph (E) of paragraph 17 of subsection
(i) of section 3216 of the insurance law, as amended by section 3 of
part M of chapter 57 of the laws of 2019, is amended to read as follows:
(v) all FDA-approved contraceptive drugs, devices, and other products,
including all over-the-counter contraceptive drugs, devices, and
products as prescribed or as otherwise authorized under state or federal
law; voluntary sterilization procedures pursuant to 42 U.S.C. 18022 and
identified in the comprehensive guidelines supported by the health
resources and services administration and thereby incorporated in the
essential health benefits benchmark plan; patient education and coun-
seling on contraception; and follow-up services related to the drugs,
devices, products, and procedures covered under this clause, including,
but not limited to, management of side effects, counseling for continued
adherence, and device insertion and removal. Except as otherwise author-
ized under this [clause] ITEM, a contract shall not impose any
restrictions or delays on the coverage required under this [clause]
ITEM. However, where the FDA has approved one or more therapeutic and
pharmaceutical equivalent, as defined by the FDA, versions of a contra-
ceptive drug, device, or product, a contract is not required to include
all such therapeutic and pharmaceutical equivalent versions in its
formulary, so long as at least one is included and covered without cost-
sharing and in accordance with this [clause] ITEM. If the covered ther-
apeutic and pharmaceutical equivalent versions of a drug, device, or
product are not available or are deemed medically inadvisable a contract
shall provide coverage for an alternate therapeutic and pharmaceutical
equivalent version of the contraceptive drug, device, or product without
cost-sharing.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD09936-05-6
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(a) This coverage shall include emergency contraception without cost
sharing when provided pursuant to a prescription, or order under section
sixty-eight hundred thirty-one of the education law or when lawfully
provided over-the-counter.
(b) If the attending health care provider, in [his or her] THEIR
reasonable professional judgment, determines that the use of a non-cov-
ered therapeutic or pharmaceutical equivalent of a drug, device, or
product is warranted, the health care provider's determination shall be
final. The superintendent shall promulgate regulations establishing a
process, including timeframes, for an insured, an insured's designee or
an insured's health care provider to request coverage of a non-covered
contraceptive drug, device, or product. Such regulations shall include a
requirement that insurers use an exception form that shall meet criteria
established by the superintendent.
(c) This coverage must allow for the dispensing of up to twelve months
worth of a contraceptive at one time.
(d) THIS COVERAGE SHALL PROVIDE FOR AN ADMINISTRATIVE FEE TO A PHARMA-
CIST WHO DISPENSES SELF-ADMINISTERED HORMONAL CONTRACEPTIVES PURSUANT TO
SECTION SIXTY-EIGHT HUNDRED ONE OF THE EDUCATION LAW AND PROVIDES
RELATED SERVICES NO LESS THAN THE CURRENT MEDICAID RATE FOR THE SAME
SERVICES.
(E) For the purposes of this [clause] ITEM, "over-the-counter contra-
ceptive products" shall mean those products provided for in comprehen-
sive guidelines supported by the health resources and services adminis-
tration as of January twenty-first, two thousand nineteen.
§ 2. Subparagraph (A) of paragraph 16 of subsection (l) of section
3221 of the insurance law, as amended by section 1 of part M of chapter
57 of the laws of 2019, is amended to read as follows:
(A) Every group or blanket policy that provides medical, major
medical, or similar comprehensive type coverage [that is issued,
amended, renewed, effective or delivered on or after January first, two
thousand twenty,] shall provide coverage for all of the following
services and contraceptive methods:
(1) All FDA-approved contraceptive drugs, devices, and other products.
This includes all FDA-approved over-the-counter contraceptive drugs,
devices, and products as prescribed or as otherwise authorized under
state or federal law. The following applies to this coverage:
(a) where the FDA has approved one or more therapeutic and pharmaceu-
tical equivalent, as defined by the FDA, versions of a contraceptive
drug, device, or product, a group or blanket policy is not required to
include all such therapeutic and pharmaceutical equivalent versions in
its formulary, so long as at least one is included and covered without
cost-sharing and in accordance with this paragraph;
(b) if the covered therapeutic and pharmaceutical equivalent versions
of a drug, device, or product are not available or are deemed medically
inadvisable a group or blanket policy shall provide coverage for an
alternate therapeutic and pharmaceutical equivalent version of the
contraceptive drug, device, or product without cost-sharing. If the
attending health care provider, in [his or her] THEIR reasonable profes-
sional judgment, determines that the use of a non-covered therapeutic or
pharmaceutical equivalent of a drug, device, or product is warranted,
the health care provider's determination shall be final. The superinten-
dent shall promulgate regulations establishing a process, including
timeframes, for an insured, an insured's designee or an insured's health
care provider to request coverage of a non-covered contraceptive drug,
device, or product. Such regulations shall include a requirement that
A. 9519 3
insurers use an exception form that shall meet criteria established by
the superintendent;
(c) this coverage shall include emergency contraception without cost-
sharing when provided pursuant to a prescription or order under section
sixty-eight hundred thirty-one of the education law or when lawfully
provided over the counter; [and]
(d) this coverage must allow for the dispensing of up to twelve months
worth of a contraceptive at one time; AND
(E) THIS COVERAGE SHALL PROVIDE FOR AN ADMINISTRATIVE FEE TO A PHARMA-
CIST WHO DISPENSES SELF-ADMINISTERED HORMONAL CONTRACEPTIVES PURSUANT TO
SECTION SIXTY-EIGHT HUNDRED ONE OF THE EDUCATION LAW AND PROVIDES
RELATED SERVICES NO LESS THAN THE CURRENT MEDICAID RATE FOR THE SAME
SERVICES;
(2) Voluntary sterilization procedures pursuant to 42 U.S.C. 18022 and
identified in the comprehensive guidelines supported by the health
resources and services administration and thereby incorporated in the
essential health benefits benchmark plan;
(3) Patient education and counseling on contraception; and
(4) Follow-up services related to the drugs, devices, products, and
procedures covered under this paragraph, including, but not limited to,
management of side effects, counseling for continued adherence, and
device insertion and removal.
§ 3. The opening paragraph and subparagraph (A) of paragraph 1 of
subsection (cc) of section 4303 of the insurance law, as amended by
section 2 of part M of chapter 57 of the laws of 2019, are amended to
read as follows:
Every contract that provides medical, major medical, or similar
comprehensive type coverage [that is issued, amended, renewed, effective
or delivered on or after January first, two thousand twenty,] shall
provide coverage for all of the following services and contraceptive
methods:
(A) All FDA-approved contraceptive drugs, devices, and other products.
This includes all FDA-approved over-the-counter contraceptive drugs,
devices, and products as prescribed or as otherwise authorized under
state or federal law. The following applies to this coverage:
(i) where the FDA has approved one or more therapeutic and pharmaceu-
tical equivalent, as defined by the FDA, versions of a contraceptive
drug, device, or product, a contract is not required to include all such
therapeutic and pharmaceutical equivalent versions in its formulary, so
long as at least one is included and covered without cost-sharing and in
accordance with this subsection;
(ii) if the covered therapeutic and pharmaceutical equivalent versions
of a drug, device, or product are not available or are deemed medically
inadvisable a contract shall provide coverage for an alternate therapeu-
tic and pharmaceutical equivalent version of the contraceptive drug,
device, or product without cost-sharing. If the attending health care
provider, in [his or her] THEIR reasonable professional judgment, deter-
mines that the use of a non-covered therapeutic or pharmaceutical equiv-
alent of a drug, device, or product is warranted, the health care
provider's determination shall be final. The superintendent shall
promulgate regulations establishing a process, including timeframes, for
an insured, an insured's designee or an insured's health care provider
to request coverage of a non-covered contraceptive drug, device, or
product. Such regulations shall include a requirement that insurers use
an exception form that shall meet criteria established by the super-
intendent;
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(iii) this coverage shall include emergency contraception without
cost-sharing when provided pursuant to a prescription or order under
section sixty-eight hundred thirty-one of the education law or when
lawfully provided over the counter; [and]
(iv) this coverage must allow for the dispensing of up to twelve
months worth of a contraceptive at one time; AND
(V) THIS COVERAGE SHALL INCLUDE AN ADMINISTRATIVE FEE TO A PHARMACIST
WHO DISPENSES SELF-ADMINISTERED HORMONAL CONTRACEPTIVES PURSUANT TO
SECTION SIXTY-EIGHT HUNDRED ONE OF THE EDUCATION LAW AND PROVIDES
RELATED SERVICES NO LESS THAN THE CURRENT MEDICAID RATE FOR THE SAME
SERVICES;
§ 4. This act shall take effect immediately and shall apply to poli-
cies and contracts issued, renewed, modified, altered or amended on and
after such date.