S 6168: Provides that every insurance policy which provides coverage for prescription drugs shall insure that there is continuous coverage of a single source drug that is part of a prescribed therapy until such prescribed therapy is no longer medically necessary for the enrollee of such policy; defines "single source drug".

  
  STATE OF NEW YORK ________________________________________________________________________ 6168 2025-2026 Regular Sessions  IN SENATE March 6, 2025 ___________ Introduced by Sen. PARKER -- 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 coverage for single source drugs The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subsection (i) of section 3216 of the insurance law is 2 amended by adding a new paragraph 40 to read as follows: 3 (40) Every individual or blanket policy delivered or issued for deliv- 4 ery in this state providing coverage for prescription drugs through the 5 use of a drug formulary shall include a provision which, in the event of 6 a change to such formulary, allows a covered person who is taking a 7 single source drug covered under such policy that is no longer included 8 in or preferred under such formulary and has filed a grievance or an 9 appeal of the denial of access to the drug with the insurer or a state 10 or federal agency or designee of such agency, to continue receiving 11 coverage for such drug under the same terms and conditions as would 12 apply under the policy were such drug still included in or preferred 13 under the formulary, until a final decision is rendered on the appeal or 14 grievance. For the purpose of this paragraph, "single source drug" means 15 a brandname drug for which there is no generic equivalent. 16 § 2. Subsection (k) of section 3221 of the insurance law is amended by 17 adding a new paragraph 24 to read as follows: 18 (24) Every group or blanket policy delivered or issued for delivery in 19 this state providing coverage for prescription drugs through the use of 20 a drug formulary shall include a provision which, in the event of a 21 change to such formulary, allows a covered person who is taking a single 22 source drug covered under such policy that is no longer included in or 23 preferred under such formulary and has filed a grievance or an appeal of 24 the denial of access to the drug with the insurer or a state or federal 25 agency or designee of such agency, to continue receiving coverage for EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02413-01-5 
 S. 6168 2 1 such drug under the same terms and conditions as would apply under the 2 policy were such drug still included in or preferred under the formu- 3 lary, until a final decision is rendered on the appeal or grievance. For 4 the purpose of this paragraph, "single source drug" means a brandname 5 drug for which there is no generic equivalent. 6 § 3. Section 4303 of the insurance law is amended by adding a new 7 subsection (ww) to read as follows: 8 (ww) Every contract delivered or issued for delivery in this state 9 providing coverage for prescription drugs through the use of a drug 10 formulary shall include a provision which, in the event of a change to 11 such formulary, allows a covered person who is taking a single source 12 drug covered under such contract that is no longer included in or 13 preferred under such formulary and has filed a grievance or an appeal of 14 the denial of access to the drug with the insurer corporation or organ- 15 ization certified pursuant to article forty-four of the public health 16 law or a state or federal agency or designee of such agency, to continue 17 receiving coverage for such drug under the same terms and conditions as 18 would apply under the contract were such drug still included in or 19 preferred under the formulary, until a final decision is rendered on the 20 appeal or grievance. For the purpose of this subsection, "single source 21 drug" means a brandname drug for which there is no generic equivalent. 22 § 4. This act shall take effect on the first of the calendar month 23 next succeeding the sixtieth day after it shall have become a law; 24 provided, however, that this act shall apply only to policies and 25 contracts issued, renewed or amended on or after such effective date.