What's happening
This bill prohibits health plans from changing prescription drug formularies during a plan year, with limited exceptions and required advance notice.
Why it matters
Ensures stability for patients. By preventing mid-year changes to prescription drug coverage, patients who rely on ongoing medications are protected from unexpected increases in costs or loss of access, which can be critical for those managing chronic or serious health conditions.
Limits exceptions to protect consumer interests. The bill allows changes only in specific cases—such as when a cheaper, equivalent generic becomes available or when the FDA determines a drug is unsafe—ensuring that plan modifications are driven by safety or cost-saving for consumers, not insurer profit motives.
Increases transparency and planning ability. The requirement for advance public notice of upcoming formulary and cost-sharing changes before open enrollment allows consumers to make informed choices when selecting or renewing their health plans, reducing the risk of “bait-and-switch” tactics.
Respects collective bargaining rights. By exempting collectively bargained plans from these restrictions, the bill preserves the ability of unions and employers to negotiate custom drug coverage arrangements, balancing worker rights with patient protections.
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Who cares
Headline styles
Stop Midyear Drug List Changes
Plain English, a few words. Used as the page title.
Sponsors
46 Co-sponsors
- Didi Barrett
- Yuh-Line Niou
- Felix Ortiz
- Sandy Galef
- Thomas Abinanti
- Charles Lavine
- William Colton
- Kimberly Jean-Pierre
- Al Taylor
- Kevin M. Byrne
- David Weprin
- Rebecca Seawright
- Charles Barron
- Walter T. Mosley
- Donna Lupardo
- Jake Ashby
- Karines Reyes
- Linda Rosenthal
- Clyde Vanel
- Albert A. Stirpe
- Daniel Rosenthal
- Judy Griffin
- Ellen C. Jaffee
- David Buchwald
- Richard Gottfried
- Anthony D'Urso
- William Magnarelli
- Steve Stern
- Pamela J. Hunter
- Jonathan Jacobson
- Mike LiPetri
- Andrew Hevesi
- Steven Otis
- Robert C. Carroll
- Phil Steck
- Jo Anne Simon
- John K. Mikulin
- Victor M. Pichardo
- Harvey Epstein
- Nily Rozic
- Monica P. Wallace
- Nicole Malliotakis
- Marianne Buttenschon
- Colin Schmitt
- Jeffrey Dinowitz
- Michael Benedetto
4 Multi-sponsors
History
- Tabled
- Vetoed memo.245
- Delivered to governor
- Returned to assembly
- Passed senateVote 56–6
- 3rd reading cal.462
- Substituted for S2849A
- Referred to rules
- Delivered to senate
- Passed assembly
- Amended on third reading 2969a
- Ordered to third reading rules cal.69
Show 5 earlier actions
- Rules report cal.69
- Reported
- Reported referred to rules
- Reported referred to codes
- 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.
Limit Midyear Drug Changes
Senate Floor Calendar · Sponsor Neil D. Breslin
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2969--A R. R. 69
2019-2020 Regular Sessions
IN ASSEMBLY
January 28, 2019
Introduced by M. of A. PEOPLES-STOKES, BARRETT, NIOU, ORTIZ, GALEF, ABINANTI, LAVINE, COLTON, JEAN-PIERRE, TAYLOR, BYRNE, WEPRIN, SEAWRIGHT, BARRON, MOSLEY, LUPARDO, ASHBY, REYES, L. ROSENTHAL, VANEL, STIRPE, D. ROSENTHAL, GRIFFIN, JAFFEE, BUCHWALD,… Show allHide
Introduced by M. of A. PEOPLES-STOKES, BARRETT, NIOU, ORTIZ, GALEF, ABINANTI, LAVINE, COLTON, JEAN-PIERRE, TAYLOR, BYRNE, WEPRIN, SEAWRIGHT, BARRON, MOSLEY, LUPARDO, ASHBY, REYES, L. ROSENTHAL, VANEL, STIRPE, D. ROSENTHAL, GRIFFIN, JAFFEE, BUCHWALD, GOTTFRIED, D'URSO, MAGNARELLI, STERN, HUNTER, JACOBSON, LiPETRI, HEVESI, OTIS, CARROLL, STECK, SIMON, MIKULIN, PICHARDO, EPSTEIN, ROZIC, WALLACE, MALLIOTAKIS, BUTTENSCHON, SCHMITT -- Multi-Sponsored by -- M. of A. ENGLEBRIGHT, RA, THIELE -- read once and referred to the Committee on Insurance -reported and referred to the Committee on Codes -- reported and referred to the Committee on Rules -- amended on the special order of third reading, ordered reprinted as amended, retaining its place on the special 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.
LBD04720-04-9
A. 2969--A 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.
(e) The provisions of this section shall not supersede the terms of a collective bargaining agreement, or the rights of labor representation groups to collectively bargain changes to the formularies.
§ 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 deduct-
A. 2969--A 3
ible, 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.
5. The provisions of this section shall not supersede the terms of a collective bargaining agreement, or the rights of labor representation groups to collectively bargain changes to the formularies.
§ 3. This act shall take effect on the sixtieth day after it shall have become a law. 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 on or before such effective date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.