S 7900: Authorizes insurance policies which provide coverage for prescription drugs where cost-sharing obligations are determined by category of prescription drugs to offer a program to insureds that utilizes rebates or discounts to lower an insured's cost-sharing for prescription drugs if the insured's cost-sharing under such program would be more favorable than the cost-sharing that would otherwise be applicable to the prescription drug.

  
  STATE OF NEW YORK ________________________________________________________________________ 7900 2025-2026 Regular Sessions  IN SENATE May 13, 2025 ___________ Introduced by Sen. BAILEY -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance AN ACT to amend the insurance law and the public health law, in relation to authorizing insurance policies which provide coverage for prescription drugs and involve cost-sharing obligations to offer a program to insureds utilizing rebates or discounts The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph 27 of subsection (i) of section 3216 of the 2 insurance law, as added by chapter 536 of the laws of 2010, is amended 3 to read as follows: 4 (27) (A) No policy delivered or issued for delivery in this state 5 which provides coverage for prescription drugs and for which cost-shar- 6 ing, deductibles or co-insurance obligations are determined by category 7 of prescription drugs shall impose cost-sharing, deductibles or co-insu- 8 rance obligations for any prescription drug that exceeds the dollar 9 amount of cost-sharing, deductibles or co-insurance obligations for 10 non-preferred brand drugs or its equivalent (or brand drugs if there is 11 no non-preferred brand drug category). 12 (B) Notwithstanding the limitations prescribed in subparagraph (A) of 13 this paragraph or any other provision of law, a policy delivered or 14 issued for delivery in this state which provides coverage for 15 prescription drugs where cost-sharing obligations are determined by 16 category of prescription drugs may offer a program to insureds that 17 utilizes rebates or discounts to lower an insured's cost-sharing for 18 prescription drugs if the insured's cost-sharing under such program 19 would be more favorable than the cost-sharing that would otherwise be 20 applicable to the prescription drug. A program offered pursuant to this 21 subparagraph shall not be deemed a separate tier of drug cost-sharing. A 22 description of the program shall be set forth in the policy or contract, 23 provided, however, such description may refer insureds to a website for EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD11644-01-5 
 S. 7900 2 1 additional information, including details regarding the insured's 2 reduced cost-sharing. 3 § 2. Paragraph 16 of subsection (a) of section 3221 of the insurance 4 law, as added by chapter 536 of the laws of 2010, is amended to read as 5 follows: 6 (16) (A) No policy delivered or issued for delivery in this state 7 which provides coverage for prescription drugs and for which cost-shar- 8 ing, deductibles or co-insurance obligations are determined by category 9 of prescription drugs shall impose cost-sharing, deductibles or co-insu- 10 rance obligations for any prescription drug that exceeds the dollar 11 amount of cost-sharing, deductibles or co-insurance obligations for 12 non-preferred brand drugs or its equivalent (or brand drugs if there is 13 no non-preferred brand drug category). 14 (B) Notwithstanding the limitations prescribed in subparagraph (A) of 15 this paragraph or any other provision of law, a policy delivered or 16 issued for delivery in this state which provides coverage for 17 prescription drugs where cost-sharing obligations are determined by 18 category of prescription drugs may offer a program to insureds that 19 utilizes rebates or discounts to lower an insured's cost-sharing for 20 prescription drugs if the insured's cost-sharing under such program 21 would be more favorable than the cost-sharing that would otherwise be 22 applicable to the prescription drug. A program offered pursuant to this 23 subparagraph shall not be deemed a separate tier of drug cost-sharing. A 24 description of the program shall be set forth in the policy or contract, 25 provided, however, such description may refer insureds to a website for 26 additional information, including details regarding the insured's 27 reduced cost-sharing. 28 § 3. Subsection (jj) of section 4303 of the insurance law, as added by 29 chapter 536 of the laws of 2010 and as relettered by section 55 of part 30 D of chapter 56 of the laws of 2013, is amended to read as follows: 31 (jj) (1) No medical expense indemnity corporation, a hospital service 32 corporation or a health service corporation which provides coverage for 33 prescription drugs and for which cost-sharing, deductibles or co-insu- 34 rance obligations are determined by category of prescription drugs shall 35 impose cost-sharing, deductibles or co-insurance obligations for any 36 prescription drug that exceeds the dollar amount of cost-sharing, deduc- 37 tibles or co-insurance obligations for non-preferred brand drugs or its 38 equivalent (or brand drugs if there is no non-preferred brand drug cate- 39 gory). 40 (2) Notwithstanding the limitations prescribed in paragraph one of 41 this subsection or any other provision of law, a medical expense indem- 42 nity corporation, a hospital service corporation or a health service 43 corporation which provides coverage for prescription drugs where cost- 44 sharing obligations are determined by category of prescription drugs may 45 offer a program to insureds that utilizes rebates or discounts to lower 46 an insured's cost-sharing for prescription drugs if the insured's cost- 47 sharing under such program would be more favorable than the cost-sharing 48 that would otherwise be applicable to the prescription drug. A program 49 offered pursuant to this paragraph shall not be deemed a separate tier 50 of drug cost-sharing. A description of the program shall be set forth in 51 the policy or contract, provided, however, such description may refer 52 insureds to a website for additional information, including details 53 regarding the insured's reduced cost-sharing. 54 § 4. Subdivision 7 of section 4406-c of the public health law, as 55 added by chapter 536 of the laws of 2010, is amended to read as follows: 
 S. 7900 3 1 7. (a) No health maintenance organization which provides coverage for 2 prescription drugs and for which cost-sharing, deductibles or co-insu- 3 rance obligations are determined by category of prescription drugs shall 4 impose cost-sharing, deductibles or co-insurance obligations for any 5 prescription drug that exceeds the dollar amount of cost-sharing, deduc- 6 tibles or co-insurance obligations for non-preferred brand drugs or its 7 equivalent (or brand drugs if there is no non-preferred brand drug cate- 8 gory). 9 (b) Notwithstanding the limitations prescribed in paragraph (a) of 10 this subdivision or any other provision of law, a health maintenance 11 organization which provides coverage for prescription drugs where cost- 12 sharing obligations are determined by category of prescription drugs may 13 offer a program to enrollees that utilizes rebates or discounts to lower 14 an enrollee's cost-sharing for prescription drugs if the enrollee's 15 cost-sharing under such program would be more favorable than the cost- 16 sharing that would otherwise be applicable to the prescription drug. A 17 program offered pursuant to this paragraph shall not be deemed a sepa- 18 rate tier of drug cost-sharing. A description of the program shall be 19 set forth in the policy or contract, provided, however, such description 20 may refer enrollees to a website for additional information, including 21 details regarding the enrollee's reduced cost-sharing. 22 § 5. This act shall take effect January 1, 2026 and shall apply to 23 policies or contracts issued, renewed, modified, altered or amended on 24 or after such date.