Bill > A03973

This bill modifies New York insurance law to expand provisions related to prescription drug formulary coverage, specifically addressing interchangeable biologics and biosimilars. The bill allows insurers to require patients to try an interchangeable biological product or biosimilar before covering a brand-name prescription drug, similar to existing rules for generic equivalents. It also permits insurers with multi-tier drug formularies to move a prescription drug to a tier with higher out-of-pocket costs when an interchangeable biological product, generic equivalent, or biosimilar is simultaneously added to the formulary. To understand the technical terms: an "interchangeable biological product" is a biologic medication deemed by the FDA to have the same clinical effect as another biologic drug, while a "biosimilar" is a biologic medication highly similar to and with no meaningful clinical differences from an already-approved biologic reference product. These changes apply to insurance policies and health corporation contracts, potentially giving insurers more flexibility in managing prescription drug coverage while potentially reducing costs for patients by encouraging the use of lower-cost alternative medications.

Budget and Finance, Business and Industry

https://www.nysenate.gov/legislation/bills/2025/A3973