NY State Senate Bill 2025-S6925

Current Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Mar 27, 2025	referred to insurance

2025-S6925 (ACTIVE) - Details

See Assembly Version of this Bill:: A3833
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L; amd §365-a, Soc Serv L
Versions Introduced in 2023-2024 Legislative Session:: S8367, A9662

2025-S6925 (ACTIVE) - Summary

Requires insurance companies, medical expense indemnity corporations, hospital service corporations, health service corporations and medical assistance programs to provide coverage for prescribed antiviral therapeutics approved by the food and drug administration for the treatment of COVID-19 at no cost to the patient.

2025-S6925 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S6925

SPONSOR: HOYLMAN-SIGAL
 
TITLE OF BILL:

An act to amend the insurance law and the social services law, in
relation to capping cost sharing for antiviral COVID-19 therapeutics

 
SUMMARY OF PROVISIONS:

Section one adds a new paragraph to section 3216 of the insurance law
requiring individual insurance policies that provide coverage for
prescription drugs to cover oral antiviral therapeutics approved by the
food and drug administration for the treatment of COVID-19 at no cost to
the insured.

Section two adds a new paragraph to section 3221 of the insurance law
requiring group insurance policies that provide coverage for
prescription drugs to cover oral antiviral therapeutics approved by the
food and drug administration for the treatment of COVID-19 at no cost to
the insured.

Section three adds a new paragraph to section 4303 of the insurance law

requiring hospital service corporations or health service corporations
insurance policies that provide coverage for prescription drugs to cover
oral antiviral therapeutics approved by the food and drug administration
for the treatment of COVID-19 at no cost to the insured.

Section four adds a new paragraph to section 365-a of the social
services law Medicaid in New York State to provide coverage for
prescription drugs to cover oral antiviral therapeutics approved by the
food and drug administration for the treatment of COVID-19 at no cost to
the insured.

 
JUSTIFICATION:

Oral antiviral therapeutics can save the life of someone with COVID-19,
having been shown to reduce the rate of serious illness and death from
COVID by as much as 89 percent. Yet a 2023 study of by the National
Institutes of Health found that only 9.7 percent of 1.3 million high-
risk patients eligible for an oral antiviral prescription had actually
received it (Hansen et al). These numbers can vary by demographic group,
with a December 2023 study by researchers at the City University of New
York finding that eligible Black and low-income patients take these
medications at even lower rates (Shen et al).

Many oral antiviral therapeutics have shifted into the commercial market
for distribution, at times costing more than $1,300 for a single
prescription. Though federal and private cost assistance programs prom-
ise to offset or eliminate the cost of a COVID-19 antiviral prescription
through 2024, many insured New Yorkers could still face out-of-pocket
costs that pose a barrier to uptake.

To ensure cost does not prohibit any New Yorker from taking life-saving
medication to treat COVID-19, this bill would require private insurers
and Medicaid to cover the full cost of COVID-19 oral antiviral therapeu-
tics for eligible New Yorkers with a prescription.

 
LEGISLATIVE HISTORY:
S.8637B (2023-2024): Passed Senate, Died in Assembly

 
FISCAL IMPLICATIONS:

None to the state.

2025-S6925 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6925
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                              March 27, 2025
                                ___________
 
 Introduced  by Sen. HOYLMAN-SIGAL -- read twice and ordered printed, and
   when printed to be committed 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

 S. 6925                             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.

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Senate Bill S6925

Sponsored By

Current Bill Status - In Senate Committee Insurance Committee

2025-S6925 (ACTIVE) - Details

2025-S6925 (ACTIVE) - Summary

2025-S6925 (ACTIVE) - Sponsor Memo

2025-S6925 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S6925

Share this bill

Sponsored By

Brad Hoylman-Sigal

Current Bill Status - In Senate Committee Insurance Committee

2025-S6925 (ACTIVE) - Details

2025-S6925 (ACTIVE) - Summary

2025-S6925 (ACTIVE) - Sponsor Memo

2025-S6925 (ACTIVE) - Bill Text download pdf

Comments