S 3485: Relates to prescription drug formulary coverage for interchangeable biologics and biosimilars.

  
  STATE OF NEW YORK ________________________________________________________________________ 3485 2025-2026 Regular Sessions  IN SENATE January 27, 2025 ___________ Introduced by Sen. HINCHEY -- read twice and ordered printed, and when printed to be committed to the Committee 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 prior 8 to providing coverage for the equivalent brand name prescription drug or 9 drugs; or]: 10 (i) requiring an insured to try an AB-rated generic equivalent or an 11 interchangeable biological product prior to providing coverage for the 12 equivalent brand name prescription drug or drugs, or 13 (ii) requiring an insured to try a biosimilar prior to providing 14 coverage for the brand name prescription reference product drug or 15 drugs. 16 § 2. Subparagraph (A) of paragraph 3 of subsection (c) of section 3242 17 of the insurance law, as added by chapter 99 of the laws of 2022, is 18 amended to read as follows: 19 (A) An insurer with a formulary that includes two or more tiers of 20 benefits providing for different deductibles, copayments or coinsurance 21 applicable to prescription drugs in each tier may move a prescription 22 drug to a tier with a larger deductible, copayment or coinsurance if an 23 AB-rated generic equivalent [or], an interchangeable biological product, 24 or biosimilar for such prescription drug is added to the formulary at 25 the same time; provided the change is not applicable to an insured who EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD03429-02-5 
 S. 3485 2 1 is already receiving such prescription drug or has been diagnosed with 2 or presented with a condition on or prior to the start of the plan year 3 that is treated by such prescription drug or is a prescription drug that 4 is or would be part of the insured's treatment plan for such condition. 5 § 3. Subparagraph (A) of paragraph 3 of subsection (c) of section 6 4329 of the insurance law, as added by chapter 99 of the laws of 2022, 7 is amended to read as follows: 8 (A) A corporation with a formulary that includes two or more tiers of 9 benefits providing for different deductibles, copayments or coinsurance 10 applicable to prescription drugs in each tier may move a prescription 11 drug to a tier with a larger deductible, copayment or coinsurance if an 12 AB-rated generic equivalent [or], an interchangeable biological product, 13 or biosimilar for such prescription drug is added to the formulary at 14 the same time; provided the change is not applicable to an insured who 15 is already receiving such prescription drug or has been diagnosed with 16 or presented with a condition on or prior to the start of the plan year 17 that is treated by such prescription drug or is a prescription drug that 18 is or would be part of the insured's treatment regimen for such condi- 19 tion. 20 § 4. Subsection (c) of section 3242 of the insurance law, as added 21 by chapter 99 of the laws of 2022, is redesignated subsection (d). 22 § 5. Subsection (c) of section 4329 of the insurance law, as added by 23 chapter 99 of the laws of 2022, is redesignated subsection (d). 24 § 6. This act shall take effect immediately.