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NY A08067
Bill
Status
9/27/2023
Primary Sponsor
Michaelle Solages
Click for details
AI Summary
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Requires insurers and health plans to cover off-formulary drugs at no additional cost beyond preferred brand name drugs when no formulary drug meets a patient's particular health care needs, with determinations subject to external appeal.
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Establishes standing prior authorization for chronic condition drugs lasting up to 12 months (or shorter based on medical evidence), with quarterly recertification allowed; excludes Schedule II/III controlled substances and medications requiring initial trial periods.
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Mandates prescription synchronization allowing patients to align refill dates with prorated daily cost-sharing and full dispensing fees for partial fills; applies to covered chronic condition medications excluding controlled substances.
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Requires insurers to maintain 30-day advance notice of prior authorization changes to providers and patients, post authorization requirements on websites, and ensure copayments do not exceed the actual price paid to pharmacies or the uninsured purchase price.
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Requires insurers to make at least 50% of manufacturer rebates available to enrollees at point of sale and must provide written explanations of benefits for each prescription; allows prescriber determination that retail pharmacy is more appropriate than mail order.
Legislative Description
Relates to access to appropriate drugs at reasonable prices, formulary exceptions, standing prior authorizations and external appeals; to access to retail pharmacies, prescription synchronization, limits on patient drug costs, explanations of benefits and rebates; to prescription drug synchronization; to pharmacy benefit management; and to limits on copayments and drug substitutions.
Last Action
referred to insurance
1/3/2024