S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3693
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 6, 2023
                                ___________
 
 Introduced by M. of A. WEPRIN -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance law, in relation to calculating an insured
   individual's  overall contribution to any out-of-pocket maximum or any
   cost-sharing requirement; and to amend a chapter of the laws  of  2022
   amending the insurance law relating to calculating an insured individ-
   ual's  overall  contribution to any out-of-pocket maximum or any cost-
   sharing requirement, as  proposed  in  legislative  bills  numbers  S.
   5299-A and A. 1741-A, in relation to the effectiveness thereof
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraph 37 of subsection  (i)  of  section  3216  of  the
 insurance  law,  as added by a chapter of the laws of 2022  amending the
 insurance law relating to calculating an  insured  individual's  overall
 contribution  to  any out-of-pocket maximum or any cost-sharing require-
 ment, as proposed in legislative bills numbers S. 5299-A and A.  1741-A,
 is amended to read as follows:
   (37) Any policy that provides coverage for  prescription  drugs  shall
 apply  any third-party payments, financial assistance, discount, voucher
 or other price reduction instrument for out-of-pocket expenses  made  on
 behalf  of  an insured individual for the cost of A prescription [drugs]
 DRUG to the insured's deductible, copayment, coinsurance,  out-of-pocket
 maximum,  or  any  other  cost-sharing requirement when calculating such
 insured individual's overall contribution to any  out-of-pocket  maximum
 or  any  cost-sharing requirement.  If under federal law, application of
 this requirement would result in health  savings  account  ineligibility
 under  26  USC  223,  this  requirement  shall  apply for health savings
 account-qualified high deductible  health  plans  with  respect  to  the
 deductible  of  such a plan after the enrollee has satisfied the minimum
 deductible under 26 USC  223,  except  for  with  respect  to  items  or
 services  that  are  preventive care pursuant to 26 USC 223(c)(2)(C), in
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04217-01-3
              

 A. 3693                             2
 
 which case the requirements of this paragraph shall apply regardless  of
 whether  the  minimum  deductible  under  26 USC 223 has been satisfied.
 THIS PARAGRAPH ONLY APPLIES TO A PRESCRIPTION DRUG THAT IS EITHER (A)  A
 BRAND-NAME DRUG WITHOUT AN AB RATED GENERIC EQUIVALENT, AS DETERMINED BY
 THE UNITED STATES FOOD AND DRUG ADMINISTRATION; OR (B) A BRAND-NAME DRUG
 WITH  AN AB RATED GENERIC EQUIVALENT, AS DETERMINED BY THE UNITED STATES
 FOOD AND DRUG ADMINISTRATION, AND THE INSURED HAS ACCESS TO  THE  BRAND-
 NAME  DRUG  THROUGH  PRIOR  AUTHORIZATION  BY THE INSURER OR THROUGH THE
 INSURER'S APPEAL PROCESS, INCLUDING ANY STEP-THERAPY PROCESS; OR  (C)  A
 GENERIC DRUG THE INSURER WILL COVER, WITH OR WITHOUT PRIOR AUTHORIZATION
 OR AN APPEAL PROCESS.
   §  2.  Paragraph 21 of subsection (l) of section 3221 of the insurance
 law, as added by a chapter of the laws of 2022   amending the  insurance
 law relating to calculating an insured individual's overall contribution
 to  any  out-of-pocket  maximum  or  any  cost-sharing  requirement,  as
 proposed in legislative bills  numbers  S.  5299-A  and  A.  1741-A,  is
 amended to read as follows:
   (21) Every group or blanket policy delivered or issued for delivery in
 this  state that provides coverage for A prescription [drugs] DRUG shall
 apply any third-party payments, financial assistance, discount,  voucher
 or  other  price reduction instrument for out-of-pocket expenses made on
 behalf of an insured individual for the cost of  prescription  drugs  to
 the insured's deductible, copayment, coinsurance, out-of-pocket maximum,
 or  any  other  cost-sharing  requirement  when calculating such insured
 individual's overall contribution to any out-of-pocket  maximum  or  any
 cost-sharing  requirement.    If  under federal law, application of this
 requirement would result in health savings account  ineligibility  under
 26 USC 223, this requirement shall apply for health savings account-qua-
 lified  high  deductible  health plans with respect to the deductible of
 such a plan after the enrollee  has  satisfied  the  minimum  deductible
 under  26 USC 223, except for with respect to items or services that are
 preventive care pursuant to 26  USC  223(c)(2)(C),  in  which  case  the
 requirements  of  this  paragraph  shall apply regardless of whether the
 minimum deductible under 26 USC 223 has been satisfied.  THIS  PARAGRAPH
 ONLY APPLIES TO A PRESCRIPTION DRUG THAT IS EITHER (A) A BRAND-NAME DRUG
 WITHOUT  AN  AB  RATED  GENERIC  EQUIVALENT, AS DETERMINED BY THE UNITED
 STATES FOOD AND DRUG ADMINISTRATION; OR (B) A BRAND-NAME DRUG WITH AN AB
 RATED GENERIC EQUIVALENT, AS DETERMINED BY THE UNITED  STATES  FOOD  AND
 DRUG  ADMINISTRATION,  AND THE INSURED HAS ACCESS TO THE BRAND-NAME DRUG
 THROUGH PRIOR AUTHORIZATION BY THE  INSURER  OR  THROUGH  THE  INSURER'S
 APPEAL  PROCESS,  INCLUDING  ANY  STEP-THERAPY PROCESS; OR (C) A GENERIC
 DRUG THE INSURER WILL COVER, WITH OR WITHOUT PRIOR AUTHORIZATION  OR  AN
 APPEAL PROCESS.
   § 3. Subsection (tt) of section 4303 of the insurance law, as added by
 a  chapter  of  the laws of 2022  amending the insurance law relating to
 calculating an insured individual's overall contribution to any  out-of-
 pocket  maximum or any cost-sharing requirement, as proposed in legisla-
 tive bills numbers S. 5299-A and  A.  1741-A,  is  amended  to  read  as
 follows:
   (tt) Every contract issued by a medical expense indemnity corporation,
 hospital   service  corporation,  or  health  service  corporation  that
 provides coverage for A prescription [drugs] DRUG shall apply any third-
 party payments, financial assistance, discount, voucher or  other  price
 reduction  instrument  for  out-of-pocket  expenses made on behalf of an
 insured individual for the cost of prescription drugs to  the  insured's
 deductible,  copayment, coinsurance, out-of-pocket maximum, or any other
 A. 3693                             3
 
 cost-sharing  requirement  when  calculating  such  insured individual's
 overall  contribution  to  any out-of-pocket maximum or any cost-sharing
 requirement. If under federal law, application of this requirement would
 result  in  health  savings account ineligibility under 26 USC 223, this
 requirement shall apply for health savings account-qualified high deduc-
 tible health plans with respect to the deductible of such a  plan  after
 the  enrollee  has  satisfied  the  minimum deductible under 26 USC 223,
 except for with respect to items or services that  are  preventive  care
 pursuant  to 26 USC 223(c)(2)(C), in which case the requirements of this
 paragraph shall apply regardless of whether the minimum deductible under
 26 USC 223 has  been  satisfied.  THIS  SUBSECTION  ONLY  APPLIES  TO  A
 PRESCRIPTION  DRUG  THAT  IS  EITHER (A) A BRAND-NAME DRUG WITHOUT AN AB
 RATED GENERIC EQUIVALENT, AS DETERMINED BY THE UNITED  STATES  FOOD  AND
 DRUG  ADMINISTRATION;  OR (B) A BRAND-NAME DRUG WITH AN AB RATED GENERIC
 EQUIVALENT, AS DETERMINED BY THE UNITED STATES FOOD  AND  DRUG  ADMINIS-
 TRATION, AND THE INSURED HAS ACCESS TO THE BRAND-NAME DRUG THROUGH PRIOR
 AUTHORIZATION  BY  THE  INSURER OR THROUGH THE INSURER'S APPEAL PROCESS,
 INCLUDING ANY STEP-THERAPY PROCESS; OR (C) A GENERIC  DRUG  THE  INSURER
 WILL COVER, WITH OR WITHOUT PRIOR AUTHORIZATION OR AN APPEAL PROCESS.
   §  4.  Section 4 of a chapter of the laws of 2022  amending the insur-
 ance  law  relating  to  calculating  an  insured  individual's  overall
 contribution  to  any out-of-pocket maximum or any cost-sharing require-
 ment, as proposed in legislative bills numbers S. 5299-A and A.  1741-A,
 is amended to read as follows:
   §  4.  This  act shall take effect on the first of [January] JULY 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.
   § 5. This act shall take effect immediately; provided,  however,  that
 sections  one,  two  and three of this act shall take effect on the same
 date and in the same manner as a chapter of the laws  of  2022  amending
 the  insurance law relating to calculating an insured individual's over-
 all contribution  to  any  out-of-pocket  maximum  or  any  cost-sharing
 requirement,  as  proposed in legislative bills numbers S. 5299-A and A.
 1741-A, takes effect.