What's happening
This bill requires insurers to count third-party payments or discounts for prescription drugs toward an insured individual's out-of-pocket maximums and cost-sharing requirements.
Why it matters
Directly benefits patients using assistance programs. By requiring insurers to count third-party payments (such as manufacturer copay cards, charity assistance, or pharmacy discounts) toward out-of-pocket limits, the bill ensures that patients actually see financial relief from these programs, rather than having their copays or deductibles reset or ignored.
Limits insurer cost-shifting. Without this law, insurers can exclude third-party payments from cost-sharing calculations, effectively shifting more costs onto patients and undermining the intended benefit of assistance programs. This bill closes that loophole.
Supports medication adherence. By making it easier for patients to reach their out-of-pocket maximums and reducing their personal financial burden, the bill may help individuals stick to their prescribed drug regimens, improving health outcomes and potentially reducing downstream health costs.
Applies broadly across insurance types. The legislation amends multiple sections of insurance law to ensure these protections apply to individual, group, and blanket health policies, as well as contracts with various types of health service corporations, maximizing the number of New Yorkers who would benefit.
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Who cares
Headline styles
Count Copay Assistance Toward Max
Plain English, a few words. Used as the page title.
Sponsors
21 Co-sponsors
History
- Referred to insurance
- 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.
Count All Drug Payment Help
In Senate Committee · Insurance · Sponsor Gustavo Rivera
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
8246
2019-2020 Regular Sessions
IN ASSEMBLY
June 10, 2019
Introduced by M. of A. GOTTFRIED -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to calculating an insured individual's overall contribution to any out-of-pocket maximum or any cost-sharing requirement
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 36 to read as follows:
(36) Any policy that provides coverage for prescription drugs shall apply any third-party payments, financial assistance, discount, voucher or other price reduction instrument for out-of-pocket expenses made on behalf of an insured individual for the cost of prescription drugs to the insured's deductible, copayment, coinsurance, out-of-pocket maximum, or any other cost-sharing requirement when calculating such insured individual's overall contribution to any out-of-pocket maximum or any cost-sharing requirement.
§ 2. Subsection (l) of section 3221 of the insurance law is amended by adding a new paragraph 21 to read as follows:
(21) Every group or blanket policy delivered or issued for delivery in this state that provides coverage for prescription drugs shall apply any third-party payments, financial assistance, discount, voucher or other price reduction instrument for out-of-pocket expenses made on behalf of an insured individual for the cost of prescription drugs to the insured's deductible, copayment, coinsurance, out-of-pocket maximum, or any other cost-sharing requirement when calculating such insured individual's overall contribution to any out-of-pocket maximum or any costsharing requirement.
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (ss) to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13146-01-9
A. 8246 2
(ss) Every contract issued by a medical expense indemnity corporation, hospital service corporation, or health service corporation that provides coverage for prescription drugs shall apply any third-party payments, financial assistance, discount, voucher or other price reduction instrument for out-of-pocket expenses made on behalf of an insured individual for the cost of prescription drugs to the insured's deductible, copayment, coinsurance, out-of-pocket maximum, or any other cost-sharing requirement when calculating such insured individual's overall contribution to any out-of-pocket maximum or any cost-sharing requirement.
§ 4. This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such 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.