Senate Bill S8869

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8869
 
                             I N  S E N A T E
 
                             January 12, 2026
                                ___________
 
 Introduced  by  Sens. SKOUFIS, ADDABBO, CLEARE, FERNANDEZ, JACKSON, LIU,
   MAY, SALAZAR, SCARCELLA-SPANTON -- read twice and ordered printed, and
   when printed to be committed to the Committee 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09936-05-6
              

 S. 8869                             2
 
 equivalent version of the contraceptive drug, device, or product without
 cost-sharing.
   (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
 S. 8869                             3
 
 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 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
 S. 8869                             4
 
 an exception form that shall meet criteria  established  by  the  super-
 intendent;
   (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.