STATE OF NEW YORK ________________________________________________________________________ 7768 2023-2024 Regular Sessions IN SENATE November 27, 2023 ___________ Introduced by Sen. HINCHEY -- read twice and ordered printed, and when printed to be committed to the Committee on Rules AN ACT to amend the insurance law, in relation to prescription drug formulary coverage for interchangeable biologics and biosimilars The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph 4 of subsection (c-1) of section 4903 of the 2 insurance law, as added by chapter 512 of the laws of 2016, is amended 3 to read as follows: 4 (4) The insured is stable on a prescription drug or drugs selected by 5 their health care professional for the medical condition under consider- 6 ation, provided that this shall not prevent a utilization review agent 7 from requiring an insured to try an AB-rated generic equivalent, an 8 interchangeable biological product , or biosimilar prior to providing 9 coverage for the equivalent brand name prescription drug or drugs; or 10 § 2. Subparagraph (A) of paragraph 3 of subsection (c) of section 3242 11 of the insurance law, as added by chapter 99 of the laws of 2022, is 12 amended to read as follows: 13 (A) An insurer with a formulary that includes two or more tiers of 14 benefits providing for different deductibles, copayments or coinsurance 15 applicable to prescription drugs in each tier may move a prescription 16 drug to a tier with a larger deductible, copayment or coinsurance if an 17 AB-rated generic equivalent [or], an interchangeable biological product, 18 or biosimilar for such prescription drug is added to the formulary at 19 the same time. 20 § 3. Subparagraph (A) of paragraph 3 of subsection (c) of section 21 4329 of the insurance law, as added by chapter 99 of the laws of 2022, 22 is amended to read as follows: 23 (A) A corporation with a formulary that includes two or more tiers of 24 benefits providing for different deductibles, copayments or coinsurance 25 applicable to prescription drugs in each tier may move a prescription EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD11861-01-3
S. 7768 2 1 drug to a tier with a larger deductible, copayment or coinsurance if an 2 AB-rated generic equivalent [or], an interchangeable biological product, 3 or biosimilar for such prescription drug is added to the formulary at 4 the same time. 5 § 4. This act shall take effect immediately.