NY A07707

Health care plans providing essential health benefits are prohibited from removing prescription drugs from formularies or moving drugs to higher cost tiers during a contract year, except at the time of enrollment or plan year issuance.

Health care plans are prohibited from adding utilization management restrictions to formulary drugs during a contract year, except at the time of enrollment or issuance of coverage.

Prohibition applies from the date open enrollment begins for a plan year through the end of that plan year.

Exception allows plans to move a drug to a higher cost tier if an AB-rated generic equivalent is simultaneously added to the formulary.

Exception allows removal of prescription drugs from formularies if the federal Food and Drug Administration determines the drug should be removed from the market.