S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7142
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 20, 2025
                                ___________
 
 Introduced  by  M.  of A. WALKER, DILAN, TAPIA, ALVAREZ, REYES, HYNDMAN,
   SEPTIMO,  DE LOS SANTOS,  ZACCARO,  JACKSON,   SANTABARBARA,   TAYLOR,
   RIVERA, CRUZ -- read once and referred to the Committee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to requiring certain health insurance issuers to certify that at least
   a  majority  of  prescription drug rebates are provided to patients at
   the point of sale
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  The insurance law is amended by adding a new section 3246
 to read as follows:
   § 3246. ENSURING FAIRNESS IN CERTAIN COST SHARING. (A) AS USED IN THIS
 SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
   (1) "DEFINED COST SHARING" MEANS A DEDUCTIBLE PAYMENT  OR  COINSURANCE
 AMOUNT  IMPOSED ON AN ENROLLEE FOR A COVERED PRESCRIPTION DRUG UNDER THE
 ENROLLEE'S HEALTH PLAN.
   (2) "INSURER" MEANS ANY HEALTH INSURANCE ISSUER  THAT  IS  SUBJECT  TO
 STATE  LAW REGULATING INSURANCE AND OFFERS HEALTH INSURANCE COVERAGE, AS
 DEFINED IN 42 U.S.C. § 300GG-91, OR  ANY  STATE  OR  LOCAL  GOVERNMENTAL
 EMPLOYER PLAN.
   (3) "PRICE PROTECTION REBATE" MEANS A NEGOTIATED PRICE CONCESSION THAT
 ACCRUES  DIRECTLY OR INDIRECTLY TO THE INSURER, OR OTHER PARTY ON BEHALF
 OF THE INSURER, IN THE EVENT OF AN INCREASE IN THE WHOLESALE ACQUISITION
 COST OF A DRUG ABOVE A SPECIFIED THRESHOLD.
   (4) "REBATE" MEANS:
   (A) NEGOTIATED PRICE CONCESSIONS INCLUDING BUT  NOT  LIMITED  TO  BASE
 PRICE  CONCESSIONS,  WHETHER  DESCRIBED  AS  A  REBATE OR OTHERWISE, AND
 REASONABLE ESTIMATES OF ANY PRICE PROTECTION  REBATES  AND  PERFORMANCE-
 BASED  PRICE  CONCESSIONS  THAT MAY ACCRUE DIRECTLY OR INDIRECTLY TO THE
 INSURER DURING THE COVERAGE YEAR FROM A MANUFACTURER, DISPENSING PHARMA-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05948-01-5
 A. 7142                             2
              

 
 CY, OR OTHER PARTY IN CONNECTION WITH THE DISPENSING  OR  ADMINISTRATION
 OF A PRESCRIPTION DRUG, AND
   (B) REASONABLE ESTIMATES OF ANY NEGOTIATED PRICE CONCESSIONS, FEES AND
 OTHER  ADMINISTRATIVE  COSTS  THAT ARE PASSED THROUGH, OR ARE REASONABLY
 ANTICIPATED TO BE PASSED THROUGH, TO THE INSURER AND SERVE TO REDUCE THE
 INSURER'S LIABILITIES FOR A PRESCRIPTION DRUG.
   (B) AN ENROLLEE'S DEFINED COST  SHARING  FOR  EACH  PRESCRIPTION  DRUG
 SHALL  BE  CALCULATED  AT  THE  POINT  OF  SALE BASED ON A PRICE THAT IS
 REDUCED BY AN AMOUNT EQUAL  TO  AT  LEAST  EIGHTY-FIVE  PERCENT  OF  ALL
 REBATES  RECEIVED,  OR TO BE RECEIVED, IN CONNECTION WITH THE DISPENSING
 OR ADMINISTRATION OF THE PRESCRIPTION DRUG. NOTHING  SHALL  PRECLUDE  AN
 INSURER  FROM DECREASING AN ENROLLEE'S DEFINED COST SHARING BY AN AMOUNT
 GREATER THAN THAT REQUIRED UNDER THIS SUBSECTION.
   (C) AN INSURER SHALL SUBMIT TO THE  SUPERINTENDENT  BY  THE  FIRST  OF
 JANUARY  OF EACH YEAR A CERTIFICATION IN A FORM TO BE ESTABLISHED BY THE
 SUPERINTENDENT ATTESTING THAT IT HAS COMPLIED WITH THE  REQUIREMENTS  OF
 SUBSECTION (B) OF THIS SECTION FOR THE PRIOR CALENDAR YEAR.
   (D)  IN  COMPLYING  WITH THE PROVISIONS OF THIS SECTION, AN INSURER OR
 ITS AGENTS SHALL NOT PUBLISH OR OTHERWISE  PUBLICLY  REVEAL  INFORMATION
 REGARDING  THE ACTUAL AMOUNT OF REBATES AN INSURER RECEIVES ON A PRODUCT
 OR THERAPEUTIC CLASS OF  PRODUCTS,  MANUFACTURER,  OR  PHARMACY-SPECIFIC
 BASIS.  SUCH  INFORMATION  SHALL BE EXEMPT FROM DISCLOSURE UNDER SECTION
 EIGHTY-SEVEN OF THE PUBLIC OFFICERS  LAW  AND  SHALL  NOT  BE  DISCLOSED
 DIRECTLY  OR  INDIRECTLY,  OR IN A MANNER THAT WOULD ALLOW FOR THE IDEN-
 TIFICATION OF AN INDIVIDUAL PRODUCT, THERAPEUTIC CLASS OF  PRODUCTS,  OR
 MANUFACTURER, OR IN A MANNER THAT WOULD HAVE THE POTENTIAL TO COMPROMISE
 THE  FINANCIAL,  COMPETITIVE, OR PROPRIETARY NATURE OF SUCH INFORMATION.
 AN INSURER SHALL IMPOSE THE CONFIDENTIALITY PROTECTIONS OF THIS SUBDIVI-
 SION ON ANY VENDOR OR DOWNSTREAM THIRD-PARTY THAT PERFORMS  HEALTH  CARE
 OR  ADMINISTRATIVE SERVICES ON BEHALF OF THE INSURER THAT MAY RECEIVE OR
 HAVE ACCESS TO REBATE INFORMATION.
   § 2. The insurance law is amended by adding a new section 4331 to read
 as follows:
   § 4331. ENSURING FAIRNESS IN CERTAIN COST SHARING. (A) AS USED IN THIS
 SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
   (1) "DEFINED COST SHARING" MEANS A DEDUCTIBLE PAYMENT  OR  COINSURANCE
 AMOUNT  IMPOSED ON AN ENROLLEE FOR A COVERED PRESCRIPTION DRUG UNDER THE
 ENROLLEE'S HEALTH PLAN.
   (2) "CORPORATION" MEANS ANY HEALTH INSURANCE ISSUER THAT IS SUBJECT TO
 STATE LAW REGULATING INSURANCE AND OFFERS HEALTH INSURANCE COVERAGE,  AS
 DEFINED  IN  42  U.S.C.  §  300GG-91, OR ANY STATE OR LOCAL GOVERNMENTAL
 EMPLOYER PLAN.
   (3) "PRICE PROTECTION REBATE" MEANS A NEGOTIATED PRICE CONCESSION THAT
 ACCRUES DIRECTLY OR INDIRECTLY TO THE CORPORATION,  OR  OTHER  PARTY  ON
 BEHALF  OF THE CORPORATION, IN THE EVENT OF AN INCREASE IN THE WHOLESALE
 ACQUISITION COST OF A DRUG ABOVE A SPECIFIED THRESHOLD.
   (4) "REBATE" MEANS:
   (A) NEGOTIATED PRICE CONCESSIONS INCLUDING BUT  NOT  LIMITED  TO  BASE
 PRICE  CONCESSIONS,  WHETHER  DESCRIBED  AS  A  REBATE OR OTHERWISE, AND
 REASONABLE ESTIMATES OF ANY PRICE PROTECTION  REBATES  AND  PERFORMANCE-
 BASED  PRICE  CONCESSIONS  THAT MAY ACCRUE DIRECTLY OR INDIRECTLY TO THE
 CORPORATION DURING THE COVERAGE YEAR  FROM  A  MANUFACTURER,  DISPENSING
 PHARMACY,  OR  OTHER PARTY IN CONNECTION WITH THE DISPENSING OR ADMINIS-
 TRATION OF A PRESCRIPTION DRUG, AND
   (B) REASONABLE ESTIMATES OF ANY NEGOTIATED PRICE CONCESSIONS, FEES AND
 OTHER ADMINISTRATIVE COSTS THAT ARE PASSED THROUGH,  OR  ARE  REASONABLY
 A. 7142                             3
 
 ANTICIPATED TO BE PASSED THROUGH, TO THE CORPORATION AND SERVE TO REDUCE
 THE CORPORATION'S LIABILITIES FOR A PRESCRIPTION DRUG.
   (B)  AN  ENROLLEE'S  DEFINED  COST  SHARING FOR EACH PRESCRIPTION DRUG
 SHALL BE CALCULATED AT THE POINT OF  SALE  BASED  ON  A  PRICE  THAT  IS
 REDUCED  BY  AN  AMOUNT  EQUAL  TO  AT  LEAST EIGHTY-FIVE PERCENT OF ALL
 REBATES RECEIVED, OR TO BE RECEIVED, IN CONNECTION WITH  THE  DISPENSING
 OR  ADMINISTRATION  OF  THE  PRESCRIPTION DRUG. NOTHING SHALL PRECLUDE A
 CORPORATION FROM DECREASING AN ENROLLEE'S DEFINED  COST  SHARING  BY  AN
 AMOUNT GREATER THAN THAT REQUIRED UNDER THIS SUBSECTION.
   (C)  A  CORPORATION SHALL SUBMIT TO THE SUPERINTENDENT BY THE FIRST OF
 JANUARY OF EACH YEAR A CERTIFICATION IN A FORM TO BE ESTABLISHED BY  THE
 SUPERINTENDENT  ATTESTING  THAT IT HAS COMPLIED WITH THE REQUIREMENTS OF
 SUBSECTION (B) OF THIS SECTION FOR THE PRIOR CALENDAR YEAR.
   (D) IN COMPLYING WITH THE PROVISIONS OF THIS SECTION, A CORPORATION OR
 ITS AGENTS SHALL NOT PUBLISH OR OTHERWISE  PUBLICLY  REVEAL  INFORMATION
 REGARDING THE ACTUAL AMOUNT OF REBATES A CORPORATION RECEIVES ON A PROD-
 UCT OR THERAPEUTIC CLASS OF PRODUCTS, MANUFACTURER, OR PHARMACY-SPECIFIC
 BASIS.  SUCH  INFORMATION  SHALL BE EXEMPT FROM DISCLOSURE UNDER SECTION
 EIGHTY-SEVEN OF THE PUBLIC OFFICERS  LAW  AND  SHALL  NOT  BE  DISCLOSED
 DIRECTLY  OR  INDIRECTLY,  OR IN A MANNER THAT WOULD ALLOW FOR THE IDEN-
 TIFICATION OF AN INDIVIDUAL PRODUCT, THERAPEUTIC CLASS OF  PRODUCTS,  OR
 MANUFACTURER, OR IN A MANNER THAT WOULD HAVE THE POTENTIAL TO COMPROMISE
 THE FINANCIAL, COMPETITIVE, OR PROPRIETARY NATURE OF SUCH INFORMATION. A
 CORPORATION  SHALL IMPOSE THE CONFIDENTIALITY PROTECTIONS OF THIS SUBDI-
 VISION ON ANY VENDOR OR DOWNSTREAM THIRD-PARTY THAT PERFORMS HEALTH CARE
 OR ADMINISTRATIVE SERVICES ON BEHALF OF THE CORPORATION THAT MAY RECEIVE
 OR HAVE ACCESS TO REBATE INFORMATION.
   § 3. The public health law is amended by adding a new section 4417  to
 read as follows:
   §  4417. ENSURING FAIRNESS IN CERTAIN COST SHARING. 1. AS USED IN THIS
 SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
   (A) "DEFINED COST SHARING" MEANS A DEDUCTIBLE PAYMENT  OR  COINSURANCE
 AMOUNT  IMPOSED ON AN ENROLLEE FOR A COVERED PRESCRIPTION DRUG UNDER THE
 ENROLLEE'S HEALTH PLAN.
   (B) "ORGANIZATION" MEANS ANY HEALTH INSURANCE ISSUER THAT  IS  SUBJECT
 TO  STATE LAW REGULATING INSURANCE AND OFFERS HEALTH INSURANCE COVERAGE,
 AS DEFINED IN 42 U.S.C. § 300GG-91, OR ANY STATE OR  LOCAL  GOVERNMENTAL
 EMPLOYER PLAN.
   (C) "PRICE PROTECTION REBATE" MEANS A NEGOTIATED PRICE CONCESSION THAT
 ACCRUES  DIRECTLY  OR  INDIRECTLY TO THE ORGANIZATION, OR OTHER PARTY ON
 BEHALF OF THE ORGANIZATION, IN THE EVENT OF AN INCREASE IN THE WHOLESALE
 ACQUISITION COST OF A DRUG ABOVE A SPECIFIED THRESHOLD.
   (D) "REBATE" MEANS:
   (I) NEGOTIATED PRICE CONCESSIONS INCLUDING BUT  NOT  LIMITED  TO  BASE
 PRICE  CONCESSIONS,  WHETHER  DESCRIBED  AS  A  REBATE OR OTHERWISE, AND
 REASONABLE ESTIMATES OF ANY PRICE PROTECTION  REBATES  AND  PERFORMANCE-
 BASED  PRICE  CONCESSIONS  THAT MAY ACCRUE DIRECTLY OR INDIRECTLY TO THE
 ORGANIZATION DURING THE COVERAGE YEAR FROM  A  MANUFACTURER,  DISPENSING
 PHARMACY,  OR  OTHER PARTY IN CONNECTION WITH THE DISPENSING OR ADMINIS-
 TRATION OF A PRESCRIPTION DRUG, AND
   (II) REASONABLE ESTIMATES OF ANY NEGOTIATED  PRICE  CONCESSIONS,  FEES
 AND  OTHER  ADMINISTRATIVE COSTS THAT ARE PASSED THROUGH, OR ARE REASON-
 ABLY ANTICIPATED TO BE PASSED THROUGH, TO THE ORGANIZATION AND SERVE  TO
 REDUCE THE ORGANIZATION'S LIABILITIES FOR A PRESCRIPTION DRUG.
   2. AN ENROLLEE'S DEFINED COST SHARING FOR EACH PRESCRIPTION DRUG SHALL
 BE  CALCULATED  AT THE POINT OF SALE BASED ON A PRICE THAT IS REDUCED BY
 A. 7142                             4

 AN AMOUNT EQUAL TO AT LEAST EIGHTY-FIVE PERCENT OF ALL REBATES RECEIVED,
 OR TO BE RECEIVED, IN CONNECTION WITH THE DISPENSING  OR  ADMINISTRATION
 OF  THE  PRESCRIPTION  DRUG. NOTHING SHALL PRECLUDE AN ORGANIZATION FROM
 DECREASING  AN ENROLLEE'S DEFINED COST SHARING BY AN AMOUNT GREATER THAN
 THAT REQUIRED UNDER THIS SUBDIVISION.
   3. AN ORGANIZATION SHALL SUBMIT TO THE SUPERINTENDENT BY THE FIRST  OF
 JANUARY  OF EACH YEAR A CERTIFICATION IN A FORM TO BE ESTABLISHED BY THE
 SUPERINTENDENT ATTESTING THAT IT HAS COMPLIED WITH THE  REQUIREMENTS  OF
 SUBDIVISION TWO OF THIS SECTION FOR THE PRIOR CALENDAR YEAR.
   4.  IN  COMPLYING WITH THE PROVISIONS OF THIS SECTION, AN ORGANIZATION
 OR ITS AGENTS SHALL NOT PUBLISH OR OTHERWISE PUBLICLY REVEAL INFORMATION
 REGARDING THE ACTUAL AMOUNT OF REBATES AN  ORGANIZATION  RECEIVES  ON  A
 PRODUCT OR THERAPEUTIC CLASS OF PRODUCTS, MANUFACTURER, OR PHARMACY-SPE-
 CIFIC  BASIS.  SUCH  INFORMATION  SHALL  BE EXEMPT FROM DISCLOSURE UNDER
 SECTION EIGHTY-SEVEN OF  THE  PUBLIC  OFFICERS  LAW  AND  SHALL  NOT  BE
 DISCLOSED  DIRECTLY  OR  INDIRECTLY, OR IN A MANNER THAT WOULD ALLOW FOR
 THE IDENTIFICATION  OF  AN  INDIVIDUAL  PRODUCT,  THERAPEUTIC  CLASS  OF
 PRODUCTS,  OR MANUFACTURER, OR IN A MANNER THAT WOULD HAVE THE POTENTIAL
 TO COMPROMISE THE FINANCIAL, COMPETITIVE, OR PROPRIETARY NATURE OF  SUCH
 INFORMATION.   AN   ORGANIZATION   SHALL   IMPOSE   THE  CONFIDENTIALITY
 PROTECTIONS OF THIS SUBDIVISION ON ANY VENDOR OR DOWNSTREAM  THIRD-PARTY
 THAT  PERFORMS  HEALTH  CARE OR ADMINISTRATIVE SERVICES ON BEHALF OF THE
 ORGANIZATION THAT MAY RECEIVE OR HAVE ACCESS TO REBATE INFORMATION.
   § 4. This act shall take effect immediately  and  apply  to  contracts
 issued, renewed or amended on or after January 1, 2025.