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NY A01287
Bill
Status
1/9/2025
Primary Sponsor
Philip Ramos
Click for details
AI Summary
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Requires all individual, group, and blanket insurance policies in New York that use drug formularies to continue coverage for single source drugs when the formulary changes and the covered person has filed a grievance or appeal
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Defines "single source drug" as a brand-name drug for which there is no generic equivalent
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Mandates that coverage must continue under the same terms and conditions as when the drug was included in or preferred under the formulary until a final decision is rendered on the appeal or grievance
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Applies to policies and contracts issued, renewed, or amended on or after the effective date, which is the first day of the calendar month following 60 days after enactment
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Amends three sections of the insurance law (sections 3216, 3221, and 4303) to cover individual policies, group policies, and health maintenance organization contracts
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
1/7/2026