S 355: Relates to program eligibility for plans comparable to Medicare part D; provides for analysis of health plans by the department of health to determine whether such health plans meet or exceed the Medicare part D standard; requires the department of health, in consultation with the department of financial services, to notify prescription drug insurers of the provisions of this act.

  
  STATE OF NEW YORK ________________________________________________________________________ 355 2025-2026 Regular Sessions  IN SENATE (Prefiled) January 8, 2025 ___________ Introduced by Sens. RIVERA, ADDABBO, COONEY, LIU, MAY, RHOADS -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the elder law, in relation to program eligibility for plans comparable to Medicare part D The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraphs (f) and (h) of subdivision 3 and subdivision 4 2 of section 242 of the elder law, paragraph (f) of subdivision 3 as 3 amended by section 1 of part T of chapter 56 of the laws of 2012, para- 4 graph (h) of subdivision 3 as amended by section 3-f of part A of chap- 5 ter 59 of the laws of 2011, and subdivision 4 as added by section 12-a 6 of part T of chapter 56 of the laws of 2012, are amended to read as 7 follows: 8 (f) As a condition of eligibility for benefits under this title, a 9 program participant is required to be enrolled in Medicare part D, or 10 any other public or private drug plan which has successfully demon- 11 strated to CMS that the coverage is as generous as, or more generous 12 than the defined standard coverage under the Medicare part D 13 prescription drug benefit, and to maintain such enrollment. For unmar- 14 ried participants with individual annual income less than or equal to 15 twenty-three thousand dollars and married participants with joint annual 16 income less than or equal to twenty-nine thousand dollars, the elderly 17 pharmaceutical insurance coverage program shall pay for the portion of 18 the part D or comparable plan monthly premium that is the responsibility 19 of the participant. Such payment shall be limited to the low-income 20 benchmark premium amount established by the federal centers for medicare 21 and medicaid services and any other amount which such agency establishes 22 under its de minimus premium policy. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD00618-01-5 
 S. 355 2 1 (h) The elderly pharmaceutical insurance coverage program is author- 2 ized to represent program participants under this title with respect to 3 their Medicare part D or comparable coverage. 4 4. As a condition of eligibility for benefits under this title, 5 participants must be enrolled in [medicare] Medicare part D, or any 6 other public or private drug plan which has successfully demonstrated to 7 CMS that the coverage is as generous as, or more generous than the 8 defined standard coverage under the Medicare part D prescription drug 9 benefit, and maintain such enrollment. For persons who meet the eligi- 10 bility requirements to participate in the elderly pharmaceutical insur- 11 ance coverage program, the program will pay for a drug covered by the 12 person's [medicare] Medicare part D plan or comparable plan or a drug in 13 a [medicare] Medicare part D excluded drug class, as defined in subdivi- 14 sion eight of section two hundred forty-one of this title, provided that 15 such drug is a covered drug, as defined in subdivision one of section 16 two hundred forty-one of this title, and that the participant complies 17 with the point of sale co-payment requirements set forth in sections two 18 hundred forty-seven and two hundred forty-eight of this title. No 19 payment shall be made for [medicare] Medicare part D or comparable plan 20 deductibles. 21 § 2. This act shall take effect on the first of April next succeeding 22 the date on which it shall have become a law.