What's happening
This bill prohibits health plans from making most prescription drug formulary changes during a contract year, with limited exceptions.
Why it matters
Ensures Prescription Drug Stability. By blocking mid-year formulary changes (like dropping drugs or increasing out-of-pocket costs), the bill gives patients and doctors greater certainty about what medications will be covered and at what cost for the entire plan year, reducing the risk of unexpected disruptions in treatment.
Limits Insurer Leverage Over Patients. The bill curtails insurers’ ability to use formulary changes as a tool to push patients toward alternative or cheaper drugs after they’ve already enrolled, which is especially important for people with chronic or complex health conditions who rely on consistent access to specific medications.
Creates Transparency and Advance Notice. Requiring at least 30 days’ notice before open enrollment about any planned changes for the next year helps patients make more informed decisions about whether to keep or change their health plan, supporting consumer choice and planning.
Allows Safety and Cost Exceptions. The bill includes exceptions for safety (allowing removal if the FDA pulls a drug or issues new safety restrictions) and for generic substitution (permitting tier changes when a generic or interchangeable biologic becomes available), balancing patient protection with cost containment and safety considerations.
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Who cares
Headline styles
Limit Midyear Drug Changes
Plain English, a few words. Used as the page title.
Sponsors
37 Co-sponsors
- Joseph P. Addabbo Jr.
- Fredrick J. Akshar II
- Brian Benjamin
- Alessandra Biaggi
- John E. Brooks
- David Carlucci
- Leroy Comrie
- Rich Funke
- Jim Gaughran
- Michael Gianaris
- Joseph A. Griffo
- Pamela Helming
- Brad Hoylman-Sigal
- Chris Jacobs
- Daphne Jordan
- Todd Kaminsky
- Anna Kaplan
- Timothy M. Kennedy
- Liz Krueger
- Andrew J. Lanza
- Kenneth P. LaValle
- Rachel May
- Shelley Mayer
- Zellnor Myrie
- Robert Ortt
- Kevin S. Parker
- Patty Ritchie
- Gustavo Rivera
- Joseph E. Robach
- Julia Salazar
- James Sanders Jr.
- Diane J. Savino
- Luis R. Sepúlveda
- Susan Serino
- José M. Serrano
- James Skoufis
- Kevin Thomas
History
- Substituted by A2969A
- Amended on third reading 2849a
- Advanced to third reading
- 2nd report cal.
- 1st report cal.462
- 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.
Stop Midyear Drug List Changes
Vetoed · Sponsor Crystal Peoples-Stokes
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2849--A Cal. No. 462
2019-2020 Regular Sessions
IN SENATE
January 29, 2019
Introduced by Sens. BRESLIN, ADDABBO, AKSHAR, BENJAMIN, BIAGGI, BROOKS, CARLUCCI, COMRIE, FUNKE, GALLIVAN, GAUGHRAN, GIANARIS, GRIFFO, HELM- ING, HOYLMAN, JACOBS, JORDAN, KAMINSKY, KENNEDY, KRUEGER, LANZA, LAVALLE, MAY, MAYER, ORTT, PARKER, RITCHIE, RIVERA,… Show allHide
Introduced by Sens. BRESLIN, ADDABBO, AKSHAR, BENJAMIN, BIAGGI, BROOKS, CARLUCCI, COMRIE, FUNKE, GALLIVAN, GAUGHRAN, GIANARIS, GRIFFO, HELM- ING, HOYLMAN, JACOBS, JORDAN, KAMINSKY, KENNEDY, KRUEGER, LANZA, LAVALLE, MAY, MAYER, ORTT, PARKER, RITCHIE, RIVERA, ROBACH, SALAZAR, SANDERS, SAVINO, SEPULVEDA, SERINO, SERRANO, SKOUFIS, THOMAS -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- reported favorably from said committee, ordered to first and second report, ordered to a third reading, amended and ordered reprinted, retaining its place in 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 year and through the end of the plan year to which such open enrollment period applies.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04720-05-9
S. 2849--A 2
(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 deductible, copayment or coinsurance requirements in the upcoming plan year, thirty days prior to the open enrollment period for the consecutive plan
S. 2849--A 3
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.
Sponsor's memo
Title of bill
An act to amend the insurance law and the public health law, in relation to prescription drug formulary changes during a contract year
Purpose or general idea of bill
To clarify that health insurance consumers covered by plans that are required to offer essential health benefits under the affordable care act are protected from adverse effects of mid-year formulary changes, and properly notified of formulary changes.
Summary of provisions
Section 1 adds a new section 4909 to the Insurance Law to state that a health care plan which provides essential health benefits under the federal affordable care act may not remove a prescription drug from a formulary during the enrollment year. If the plan's drug formulary has two or more tiers of drug benefits with different deductibles, copay- ments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the enrollment year. The plan may also not add new or additional formulary restrictions during the enrollment year. A health care plan may move a prescription drug to a tier with a larger copayment, coinsurance and different deductible if an AB-rated generic equivalent drug or interchangeable biological product is added to the formulary at the same time. In addition, provide notice to policyholders of the intent to remove a prescription drugs 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 consec- utive plan year. This section also provides that terms of a collective bargaining agreement shall not be superseded.
Read the full memo (730 words)
Section 2 adds a new section 4909 to the public health law to also state that a health care plan which provides essential health benefits under the federal affordable care act may not remove a prescription drug from a formulary during the enrollment year. If the plan's drug formulary has two or more tiers of drug benefits with different deductibles, copay- ments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the enrollment year. The plan may also not add new or additional formulary restrictions during the enrollment year A health care plan may move a prescription drug to a tier with a larger copayment, coinsurance and different deductible if an AB-rated generic equivalent drug or interchangeable biological product is added to the formulary at the same time. In addition, provide notice to policyholders of the intent to remove a prescription drugs 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 consec- utive plan year. This section also provides that terms of a collective bargaining agreement shall not be superseded.
Section 3 provides that this act would take effect on the 60th day after enactment, provided that effective immediately the superintendent of insurance may make regulations and take other actions necessary to implement the act.
Difference between original and amended version (if applicable)
The amendments to this bill clarify that this act shall not supersede a collective bargaining agreement or the rights of labor organizations to collectively bargain changes to formularies.
Justification
This bill ensures that enrollees who select a health exchange plan based on their individual prescription drug needs have assurance that the health plan will maintain continuity in coverage for those prescription drugs during the course of the enrollment year, and be provided adequate notice of the intent to remove a prescription on the upcoming plan year. Enrollees choose health exchange plans based on the formulary status of a necessary therapy.
A change in prescription drug availability could result in serious medical problems for the enrollee. Also, these unexpected formulary changes can be extremely financially burdensome and have negative health outcomes.
Prior legislative history
A.2317-C of 2017/2018; A.7707A of 2015/2016 2018: S.5022c - Referred to Insurance 2016: S.5382a - Referred to Insurance
Fiscal implications for state and local governments
None.
Effective date
This act shall take effect on the sixtieth day after it shall have become a law; provided, however, that effective immediately, the addi- tion, 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.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.