S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6917
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 18, 2025
                                ___________
 
 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 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.  Clause  (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, a contract shall not impose any restrictions  or
 delays  on  the coverage required under this clause.  However, where the
 FDA has approved one or more therapeutic and pharmaceutical  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 clause. If the covered therapeutic  and  pharmaceutical  equivalent
 versions  of  a drug, device, or product are not available or are deemed
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09936-02-5
              

 A. 6917                             2
 
 medically inadvisable a contract shall provide coverage for an alternate
 therapeutic and pharmaceutical 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 REIMBURSEMENT TO A PHARMACIST  WHO
 PRESCRIBES   AND  DISPENSES  CONTRACEPTIVE  DRUGS,  DEVICES,  AND  OTHER
 PRODUCTS AND SERVICES THE SAME AS ANY OTHER HEALTH CARE PROVIDER.
   (E) For the purposes of this clause,  "over-the-counter  contraceptive
 products" shall mean those products provided for in comprehensive guide-
 lines  supported  by the health resources and services administration 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
 care provider to request coverage of a non-covered  contraceptive  drug,
 A. 6917                             3
 
 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 REIMBURSEMENT TO A PHARMACIST  WHO
 PRESCRIBES   AND  DISPENSES  CONTRACEPTIVE  DRUGS,  DEVICES,  AND  OTHER
 PRODUCTS AND SERVICES THE SAME AS ANY OTHER HEALTH CARE PROVIDER;
   (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
 an exception form that shall meet criteria  established  by  the  super-
 intendent;
 A. 6917                             4
 
   (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  REIMBURSEMENT  TO  A  PHARMACIST  WHO
 PRESCRIBES   AND  DISPENSES  CONTRACEPTIVE  DRUGS,  DEVICES,  AND  OTHER
 PRODUCTS AND SERVICES THE SAME AS ANY OTHER HEALTH CARE PROVIDER;
   § 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.