NY State Senate Bill 2025-S7900

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

Please enter your contact information

First Name

Last Name

Email Address

A valid email address is required.

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 13, 2025	referred to insurance

2025-S7900 (ACTIVE) - Details

See Assembly Version of this Bill:: A8136
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L; amd §4406-c, Pub Health L

2025-S7900 (ACTIVE) - Summary

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.

2025-S7900 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S7900

SPONSOR: BAILEY
 
TITLE OF BILL:

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

 
PURPOSE OR GENERAL IDEA OF BILL:

To allow health insurance plans to offer prescription drug cost-sharing
assistance programs designed to help insureds access medications at
significantly reduced or no cost.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends insurance law section 3216 to permit policies that
provide coverage for 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.

Section 2 amends insurance law section 3221 to permit policies that
provide coverage for 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.

Section 3 amends insurance law section 4303 to permit medical expense
indemnity corporations, hospital service corporations or a health
service corporations, that provide coverage for 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.

Section 4 amends public health law section 4406-c to permit health main-
tenance organizations that provide coverage for 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.

 
JUSTIFICATION:

Currently, health insurance plans that provide prescription coverage in
New York are unable to leverage drug manufacturers' rebates to offer
programs that provide cost-sharing assistance to insureds who use these
medications because these programs are viewed as a fourth tier of
prescription drug cost-sharing. These assistance programs are intended
to help reduce or eliminate patients' out-of-pocket costs for certain
prescription drugs.

Allowing health insurance plans more flexibility in cost-sharing for
prescription drugs leads to more choices and less out-of-pocket costs
for patients. Programs such as "Save On" leverage the copay assistance
so that insureds' cost-sharing would often be as little as $0 for many
drugs.

This bill would allow health insurance plans to offer these programs and
would ensure that these programs are not considered a fourth tier of
prescription drug cost-sharing, as these programs would lower cost-shar-
ing, not increase it. Such programs also permit insureds, particularly
those who are covered under a high-deductible health plans, to find
lower prices for prescription drugs, including through the use of gener-
ic medications. When prescription drugs are more affordable, individuals
are more likely to be adherent to their treatment plan, avoiding down-
stream medical costs and, most importantly, achieving better health
outcomes.

 
PRIOR LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
January 1, 2026 and shall apply to policies or contracts issued,
renewed, modified, altered or amended on or after such date.

2025-S7900 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7900
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               May 13, 2025
                                ___________
 
 Introduced  by  Sen.  BAILEY -- 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 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

 S. 7900                             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:
 S. 7900                             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.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Senate Bill S7900

Sponsored By

Current Bill Status - In Senate Committee Insurance Committee

2025-S7900 (ACTIVE) - Details

2025-S7900 (ACTIVE) - Summary

2025-S7900 (ACTIVE) - Sponsor Memo

2025-S7900 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S7900

Share this bill

Sponsored By

Jamaal T. Bailey

Current Bill Status - In Senate Committee Insurance Committee

2025-S7900 (ACTIVE) - Details

2025-S7900 (ACTIVE) - Summary

2025-S7900 (ACTIVE) - Sponsor Memo

2025-S7900 (ACTIVE) - Bill Text download pdf

Comments