NY A08697

Repeals Section 4909 of the Insurance Law and Public Health Law added in 2021 regarding prescription drug formulary changes during contract years.

Prohibits insurers and health care corporations from removing drugs from formularies, moving drugs to higher cost tiers, or adding utilization management restrictions during a plan year, with exceptions only at enrollment, issuance, or renewal.

Allows moving a drug to a higher cost tier if an AB-rated generic equivalent or interchangeable biological product is added simultaneously, or removes a drug only if the FDA determines it should be removed from the market.

Permits moving a drug to a higher copayment tier during the plan year only for new patients who are not already receiving the drug or diagnosed with a condition treated by that drug at the start of the plan year.

Requires insurers to provide 90-day advance notice to policyholders before removing a drug or altering cost-sharing requirements, with notices posted on online formularies and prescription drug finder systems; exempts collective bargaining agreements.

Effective date changed from 60 days after enactment to January 1, 2023 for all policies issued, renewed, modified, altered, or amended on or after that date.