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NY A04494
Bill
Status
2/16/2023
Primary Sponsor
Philip Ramos
Click for details
AI Summary
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Requires individual and blanket health insurance policies to maintain coverage for single source drugs (brand-name drugs without generic equivalents) when a formulary change removes or deprioritizes the drug, if the policyholder has filed a grievance or appeal with the insurer or a state/federal agency.
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Coverage must continue under the same terms and conditions as before the formulary change until a final decision is rendered on the appeal or grievance.
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Applies the same requirement to group and blanket health insurance policies, and to health maintenance organization contracts.
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Defines "single source drug" as a brand-name drug for which there is no generic equivalent.
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Takes effect on the first calendar month after sixty days following enactment, applying only to policies and contracts issued, renewed, or amended on or after the effective date.
Legislative Description
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".
Last Action
referred to insurance
1/3/2024