Bill > A05282

This bill introduces comprehensive reforms to prescription drug coverage and pharmacy practices in New York, focusing on improving patient access to medications and reducing out-of-pocket costs. The bill establishes several key provisions: insurers and health maintenance organizations must create procedures to cover off-formulary drugs when no formulary drug adequately meets a patient's medical needs, implement standing prior authorizations for chronic condition medications (typically valid for 12 months), and provide transitional coverage when drugs are removed from formularies. The legislation also mandates prescription drug synchronization, allowing patients to align multiple medication refills, and requires insurers to apply prorated daily cost-sharing rates for partial prescription fills. Additionally, the bill includes transparency measures such as requiring insurers to make prior authorization requirements publicly available, mandating that copayments do not exceed the actual price paid to pharmacies, and establishing requirements for rebate disclosure. The bill aims to reduce administrative barriers, improve medication management for patients with chronic conditions, and provide more predictable and affordable prescription drug coverage. The provisions will apply to insurance policies issued or renewed on or after January 1, 2026.

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https://www.nysenate.gov/legislation/bills/2025/A5282