S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9662
 
                           I N  A S S E M B L Y
 
                              March 27, 2024
                                ___________
 
 Introduced by M. of A. WEPRIN -- read once and referred 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 39 to read as follows:
   (39) (A) EVERY POLICY THAT PROVIDES COVERAGE FOR HOSPITAL, SURGICAL OR
 MEDICAL CARE OR 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 OR
 FURNISHED  BY  A LICENSED HEALTH CARE PROVIDER ACTING WITHIN THEIR SCOPE
 OF PRACTICE AND THE STANDARD OF CARE.
   (B) THE COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF  THIS  PARA-
 GRAPH  SHALL  NOT  BE  SUBJECT  TO  ANNUAL  DEDUCTIBLES  OR COINSURANCE,
 PROVIDED, HOWEVER, THAT AN INSURED WHO  IS  ELIGIBLE  FOR  AND  ABLE  TO
 OBTAIN  FREE  PRESCRIBED  ANTIVIRAL THERAPEUTICS 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 23 to read as follows:
   (23) (A) EVERY POLICY THAT PROVIDES COVERAGE FOR HOSPITAL, SURGICAL OR
 MEDICAL  CARE OR 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 OR
 FURNISHED BY A LICENSED HEALTH CARE PROVIDER ACTING WITHIN  THEIR  SCOPE
 OF PRACTICE AND THE STANDARD OF CARE.
   (B)  THE  COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS PARA-
 GRAPH SHALL  NOT  BE  SUBJECT  TO  ANNUAL  DEDUCTIBLES  OR  COINSURANCE,
 PROVIDED,  HOWEVER,  THAT  AN  INSURED  WHO  IS ELIGIBLE FOR AND ABLE TO
 OBTAIN FREE PRESCRIBED ANTIVIRAL THERAPEUTICS UNDER  A  MANUFACTURER  OR
 GOVERNMENT  PROGRAM  MAY  BE  REQUIRED  TO USE SUCH PROGRAM BEFORE USING
 COVERAGE REQUIRED PURSUANT TO THIS PARAGRAPH.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD14144-03-4
 A. 9662                             2
 
   § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (vv) to read as follows:
   (VV)  (1)  EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPO-
 RATION, A HOSPITAL SERVICE CORPORATION OR A HEALTH  SERVICE  CORPORATION
 FOR  DELIVERY  IN  THIS  STATE THAT PROVIDES MEDICAL, HOSPITAL, SURGICAL
 CARE, OR  MAJOR  MEDICAL  OR  SIMILAR  COMPREHENSIVE-TYPE  COVERAGE  AND
 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 OR FURNISHED BY A LICENSED HEALTH CARE PROVIDER ACTING WITHIN
 THEIR SCOPE OF PRACTICE AND THE STANDARD OF CARE.
   (2)  SUCH  COVERAGE  REQUIRED  PURSUANT  TO  PARAGRAPH  ONE  OF   THIS
 SUBSECTION  SHALL  NOT  BE SUBJECT TO ANNUAL DEDUCTIBLES OR COINSURANCE,
 PROVIDED, HOWEVER, THAT AN INSURED WHO  IS  ELIGIBLE  FOR  AND  ABLE  TO
 OBTAIN  FREE  PRESCRIBED  ANTIVIRAL THERAPEUTICS UNDER A MANUFACTURER OR
 GOVERNMENT PROGRAM MAY BE REQUIRED TO  USE  SUCH  PROGRAM  BEFORE  USING
 COVERAGE REQUIRED PURSUANT TO THIS PARAGRAPH.
   §  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 OR FURNISHED BY A LICENSED HEALTH CARE PROVIDER
 ACTING WITHIN THEIR SCOPE OF PRACTICE AND THE STANDARD OF CARE.
   (II) COVERAGE REQUIRED PURSUANT TO THIS PARAGRAPH SHALL BE PROVIDED AT
 NO COST TO THE INSURED, PROVIDED, HOWEVER, THAT AN INSURED WHO IS ELIGI-
 BLE FOR AND ABLE TO OBTAIN FREE PRESCRIBED ANTIVIRAL THERAPEUTICS  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 immediately and shall apply to any
 policy or contract issued, renewed, modified, altered, or amended on  or
 after January 1, 2025.