Bill Text: NY A09055 | 2023-2024 | General Assembly | Introduced

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

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced - Dead) 2024-02-05 - referred to insurance [A09055 Detail]

Download: New_York-2023-A09055-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          9055

                   IN ASSEMBLY

                                    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:

     1    Section  1.    Paragraph  4 of subsection (c-1) of section 4903 of the
     2  insurance law, as added by chapter 512 of the laws of 2016,  is  amended
     3  to read as follows:
     4    (4)  The insured is stable on a prescription drug or drugs selected by
     5  their health care professional for the medical condition under consider-
     6  ation, provided that this shall not prevent a utilization  review  agent
     7  from  requiring  an  insured  to  try an AB-rated generic equivalent, an
     8  interchangeable biological product , or biosimilar  prior  to  providing
     9  coverage for the equivalent brand name prescription drug or drugs; or
    10    § 2. Subparagraph (A) of paragraph 3 of subsection (c) of section 3242
    11  of  the  insurance  law,  as added by chapter 99 of the laws of 2022, is
    12  amended to read as follows:
    13    (A) An insurer with a formulary that includes two  or  more  tiers  of
    14  benefits  providing for different deductibles, copayments or coinsurance
    15  applicable to prescription drugs in each tier may  move  a  prescription
    16  drug  to a tier with a larger deductible, copayment or coinsurance if an
    17  AB-rated generic equivalent [or], an interchangeable biological product,
    18  or biosimilar for such prescription drug is added to  the  formulary  at
    19  the same time.
    20    §  3.    Subparagraph  (A) of paragraph 3 of subsection (c) of section
    21  4329 of the insurance law, as added by chapter 99 of the laws  of  2022,
    22  is amended to read as follows:
    23    (A)  A corporation with a formulary that includes two or more tiers of
    24  benefits providing for different deductibles, copayments or  coinsurance
    25  applicable  to  prescription  drugs in each tier may move a prescription
    26  drug to a tier with a larger deductible, copayment or coinsurance if  an
    27  AB-rated generic equivalent [or], an interchangeable biological product,
    28  or  biosimilar  for  such prescription drug is added to the formulary at
    29  the same time.
    30    § 4.  This act shall take effect immediately.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11861-01-3