Bill > S06168

This bill requires insurance policies that provide prescription drug coverage to ensure continuous coverage of a single source drug (defined as a brand-name drug without a generic equivalent) during an appeal process. Specifically, if an insurance formulary changes and removes or de-prioritizes a single source drug that a patient is currently taking, the patient can continue receiving coverage for that drug under the same terms and conditions while they file a grievance or appeal with the insurer or a state or federal agency. This protection applies to individual, group, and blanket insurance policies in New York state. The bill aims to protect patients from sudden interruptions in their prescribed medication regimen due to formulary changes by requiring insurers to maintain coverage until the appeal process is completed. The legislation will take effect on the first day of the calendar month following 60 days after it becomes law, and will only apply to policies issued, renewed, or amended after that date.

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https://www.nysenate.gov/legislation/bills/2025/S6168