New York Assembly Bill A08136

New York 2025-2026 Regular Session

• Introduced: 5/1/25
• Refer: 5/1/25

Caption

Authorizes insurance policies which provide coverage for prescription drugs where cost-sharing obligations are determined by category of prescription drugs to offer a program to insureds that utilizes rebates or discounts to lower an insured's cost-sharing for prescription drugs if the insured's cost-sharing under such program would be more favorable than the cost-sharing that would otherwise be applicable to the prescription drug.

Impact

The impact of A08136 on state laws is significant, as it modifies existing provisions concerning how cost-sharing obligations are handled for prescription drugs. By allowing insurers to implement programs that utilize rebates or discounts, the bill aims to create a more flexible and beneficial cost-sharing structure for insured individuals. This legislative change is expected to provide immediate financial relief to patients, particularly those who may struggle with high out-of-pocket costs associated with prescription medications.

Summary

Bill A08136 proposes amendments to the insurance and public health laws in New York, specifically addressing the coverage of prescription drugs under insurance policies. It allows for insurance policies which offer coverage for prescription drugs to provide a program utilizing rebates or discounts. These rebates are intended to lower the insured's cost-sharing obligations below the standard cost-sharing applicable to the prescription drugs under their current plan. The bill aims to enhance affordability for patients who rely on medications covered by their health insurance.

Contention

Notable points of contention regarding A08136 may arise around how the implementation of such rebate programs will be regulated and whether they adequately protect consumers. Critics could argue that while the intention is to reduce costs, the potential for increased complexities in coverage terms may lead to confusion among insured individuals. Additionally, concerns may also surface regarding how these changes could affect the overall pricing and availability of certain drugs in the marketplace, given the involvement of rebate structures.