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NY A05282
Bill
Status
2/12/2025
Primary Sponsor
Michaelle Solages
Click for details
AI Summary
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Requires insurers and HMOs to cover off-formulary prescription drugs at no additional cost beyond preferred brand name copays when no formulary drug provides appropriate therapeutic benefits for a patient's specific health needs
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Establishes standing prior authorization periods of up to 12 months for chronic condition medications, with quarterly certification requirements if the condition may change, and prohibits this for Schedule II or Schedule III hydrocodone-containing controlled substances
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Mandates 90-day transitional coverage for new enrollees currently on non-formulary medications for chronic or acute conditions, and continued coverage through the plan year when drugs are removed from formulary or moved to higher cost-sharing tiers
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Requires insurers to permit prescription synchronization for chronic illness medications with prorated cost-sharing, while paying full dispensing fees to pharmacies for partial fills
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Prohibits copayments from exceeding the total price paid to the pharmacy for a drug, requires insurers to pass through at least 50% of manufacturer rebates to enrollees at point of sale, and mandates written explanation of benefits for each prescription filled
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
1/7/2026