What's happening
This bill prohibits health insurance plans from making most changes to prescription drug formularies during a plan year, except in limited cases, and requires advance notice to policyholders.
Why it matters
Protects patients from mid-year drug coverage disruptions. By restricting insurance plans from removing drugs, increasing costs, or adding restrictions after enrollment, patients can better rely on their coverage and avoid unexpected out-of-pocket expenses or interruption of ongoing treatments.
Improves transparency and planning for consumers. The required advance notice of any upcoming formulary or cost changes helps patients and providers make informed decisions during open enrollment, rather than facing sudden changes after selecting a plan.
Limits exceptions to urgent or beneficial circumstances. The only allowed mid-year formulary changes are when a cheaper, equivalent generic or biosimilar is added (potentially lowering costs), or when the FDA deems a drug unsafe—helping to balance patient stability with safety and affordability.
Enhances accountability for insurers. By mandating public posting of planned changes both online and in drug finder tools, the bill increases insurer responsibility and public oversight, potentially leading to fairer plan management practices.
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Who cares
Headline styles
Stop Midyear Drug Switches
Plain English, a few words. Used as the page title.
Sponsors
17 Co-sponsors
4 Multi-sponsors
History
- Recommitted to insurance
- Returned to senate
- Repassed assembly
- Amended on third reading 2317c
- Vote reconsidered - restored to third reading
- Returned to assembly
- Recalled from senate
- Referred to insurance
- Delivered to senate
- Passed assembly
- Amended on third reading 2317b
- Ordered to third reading cal.171
Show 9 earlier actions
- Returned to assembly
- Died in senate
- Referred to rules
- Delivered to senate
- Passed assembly
- Amended on third reading (t) 2317a
- Advanced to third reading cal.390
- Reported
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Freeze Drug Formularies Yearly
In Senate Committee · Insurance · Sponsor Susan Serino
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2317--C Cal. No. 171
2017-2018 Regular Sessions
IN ASSEMBLY
January 17, 2017
Introduced by M. of A. PEOPLES-STOKES, SKOUFIS, BARRETT, NIOU, ORTIZ, SEPULVEDA, GALEF, ABINANTI, LAVINE, COLTON, JEAN-PIERRE, TAYLOR, BYRNE, WEPRIN -- Multi-Sponsored by -- M. of A. ENGLEBRIGHT, HEVESI, RA -- read once and referred to the Committee on… Show allHide
Introduced by M. of A. PEOPLES-STOKES, SKOUFIS, BARRETT, NIOU, ORTIZ, SEPULVEDA, GALEF, ABINANTI, LAVINE, COLTON, JEAN-PIERRE, TAYLOR, BYRNE, WEPRIN -- Multi-Sponsored by -- M. of A. ENGLEBRIGHT, HEVESI, RA -- read once and referred to the Committee on Insurance -- reported from committee, advanced to a third reading, amended and ordered reprinted, retaining its place on the order of third reading -ordered to a third reading, amended and ordered reprinted, retaining its place on the order of third reading -- passed by Assembly and delivered to the Senate, recalled from the Senate, vote reconsidered, bill amended, ordered reprinted, retaining its place on the order of third reading
AN ACT to amend the insurance law and the public health law, in relation to prescription drug formulary changes during a contract year
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. The insurance law is amended by adding a new section 4909 to read as follows:
§ 4909. Prescription drug formulary changes. (a) Except as otherwise provided in subsection (c) of this section, a health care plan shall not:
(i) remove a prescription drug from a formulary;
(ii) move a prescription drug to a tier with a larger deductible, copayment, or coinsurance if the formulary includes two or more tiers of benefits providing for different deductibles, copayments or coinsurance applicable to the prescription drugs in each tier; or
(iii) add utilization management restrictions to a prescription drug on a formulary, unless such changes occur at the time of enrollment or issuance of coverage.
(b) Prohibitions provided in subsection (a) of this section shall apply beginning on the date on which open enrollment begins for a plan
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05529-11-8
A. 2317--C 2
year and through the end of the plan year to which such open enrollment period applies.
(c) (i) A health care plan with a formulary that includes two or more tiers of benefits providing for different deductibles, copayments or coinsurance applicable to prescription drugs in each tier may move a prescription drug to a tier with a larger deductible, copayment or coinsurance if an AB-rated generic equivalent or interchangeable biological product for such prescription drug is added to the formulary at the same time.
(ii) A health care plan may remove a prescription drug from a formulary if the federal Food and Drug Administration determines that such prescription drug should be removed from the market, including new utilization management restrictions issued pursuant to federal Food and Drug Administration safety concerns.
(d) A health care plan shall provide notice to policyholders of the intent to remove a prescription drug from a formulary or alter deductible, copayment or coinsurance requirements in the upcoming plan year, thirty days prior to the open enrollment period for the consecutive plan year. Such notice of impending formulary and deductible, copayment or coinsurance changes shall also be posted on the plan's online formulary and in any prescription drug finder system that the plan provides to the public.
§ 2. The public health law is amended by adding a new section 4909 to read as follows:
§ 4909. Prescription drug formulary changes. 1. Except as otherwise provided in subdivision three of this section, a health care plan shall not:
(a) remove a prescription drug from a formulary;
(b) move a prescription drug to a tier with a larger deductible, copayment, or coinsurance if the formulary includes two or more tiers of benefits providing for different deductibles, copayments or coinsurance applicable to the prescription drugs in each tier; or
(c) add utilization management restrictions to a prescription drug on a formulary, unless such changes occur at the time of enrollment or issuance of coverage.
2. Prohibitions provided in subdivision one of this section shall apply beginning on the date on which open enrollment begins for a plan year and through the end of the plan year to which such open enrollment period applies.
3. (a) A health care plan with a formulary that includes two or more tiers of benefits providing for different deductibles, copayments or coinsurance applicable to prescription drugs in each tier may move a prescription drug to a tier with a larger deductible, copayment or coinsurance if an AB-rated generic equivalent or interchangeable biological product for such prescription drug is added to the formulary at the same time.
(b) A health care plan may remove a prescription drug from a formulary if the federal Food and Drug Administration determines that such prescription drug should be removed from the market, including new utilization management restrictions issued pursuant to federal Food and Drug Administration safety concerns.
4. A health care plan shall provide notice to policyholders of the intent to remove a prescription drug from a formulary or alter deductible, copayment or coinsurance requirements in the upcoming plan year, thirty days prior to the open enrollment period for the consecutive plan year. Such notice of impending formulary and deductible, copayment or
A. 2317--C 3
coinsurance changes shall also be posted on the plan's online formulary and in any prescription drug finder system that the plan provides to the public.
§ 3. This act shall take effect on the sixtieth day after it shall have become a law; provided, however, that effective immediately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date are authorized to be made and completed by the superintendent of financial services on or before such date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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