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
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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.