Assembly Bill A9055

2023-2024 Legislative Session

Relates to prescription drug formulary coverage for interchangeable biologics and biosimilars

download bill text pdf

Sponsored By

Current Bill Status - In Assembly 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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2023-A9055 (ACTIVE) - Details

See Senate Version of this Bill:
S7768
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§4903, 3242 & 4329, Ins L

2023-A9055 (ACTIVE) - Summary

Relates to prescription drug formulary coverage for interchangeable biologics and biosimilars.

2023-A9055 (ACTIVE) - Bill Text download pdf 

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9055
 
                           I N  A S S E M B L Y
 
                             February 5, 2024
                                ___________
 
 Introduced by M. of A. McDONALD -- read once and referred to the Commit-
   tee on Insurance
 
 AN  ACT  to  amend  the  insurance law, in relation to prescription drug
   formulary coverage for interchangeable biologics and biosimilars
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.    Paragraph  4 of subsection (c-1) of section 4903 of the
 insurance law, as added by chapter 512 of the laws of 2016,  is  amended
 to read as follows:
   (4)  The insured is stable on a prescription drug or drugs selected by
 their health care professional for the medical condition under consider-
 ation, provided that this shall not prevent a utilization  review  agent
 from  requiring  an  insured  to  try an AB-rated generic equivalent, AN
 INTERCHANGEABLE BIOLOGICAL PRODUCT , OR BIOSIMILAR  prior  to  providing
 coverage for the equivalent brand name prescription drug or drugs; or
   § 2. Subparagraph (A) of paragraph 3 of subsection (c) of section 3242
 of  the  insurance  law,  as added by chapter 99 of the laws of 2022, is
 amended to read as follows:
   (A) An insurer with a formulary that includes two  or  more  tiers  of
 benefits  providing for different deductibles, copayments or coinsurance
 applicable to prescription drugs in each tier may  move  a  prescription
 drug  to a tier with a larger deductible, copayment or coinsurance if an
 AB-rated generic equivalent [or], AN interchangeable biological product,
 OR BIOSIMILAR for such prescription drug is added to  the  formulary  at
 the same time.
   §  3.    Subparagraph  (A) of paragraph 3 of subsection (c) of section
 4329 of the insurance law, as added by chapter 99 of the laws  of  2022,
 is amended to read as follows:
   (A)  A corporation with a formulary that includes two or more tiers of
 benefits providing for different deductibles, copayments or  coinsurance
 applicable  to  prescription  drugs in each tier may move a prescription
 drug to a tier with a larger deductible, copayment or coinsurance if  an
 AB-rated generic equivalent [or], AN interchangeable biological product,
 OR  BIOSIMILAR  for  such prescription drug is added to the formulary at
 the same time.
   § 4.  This act shall take effect immediately.

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