STATE OF NEW YORK
________________________________________________________________________
6917--A
2025-2026 Regular Sessions
IN ASSEMBLY
March 18, 2025
___________
Introduced by M. of A. McDONALD, LAVINE, RAGA, BURDICK, STECK, BARRETT,
CRUZ, ANGELINO, DAVILA, KAY, RAMOS, SEAWRIGHT, BURROUGHS, KASSAY,
PHEFFER AMATO, REYES, BEEPHAN, MILLER, LUNSFORD, PAULIN, GALLAGHER,
TAPIA, SHRESTHA, EPSTEIN, GLICK, EACHUS, DE LOS SANTOS, ROZIC, SHIM-
SKY, LUPARDO, R. CARROLL, LEVENBERG, STIRPE, McMAHON, BORES, WEPRIN,
WOERNER, JACOBSON, STERN -- read once and referred to the Committee on
Insurance -- reported and referred to the Committee on Rules -- Rules
Committee discharged, bill amended, ordered reprinted as amended and
recommitted to the Committee on Rules
AN ACT to amend the insurance law, in relation to requiring certain
health insurance policies include coverage services provided by phar-
macists related to contraceptives
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Clause (v) of subparagraph (E) of paragraph 17 of
2 subsection (i) of section 3216 of the insurance law, as amended by
3 section 3 of part M of chapter 57 of the laws of 2019, is amended to
4 read as follows:
5 (v) all FDA-approved contraceptive drugs, devices, and other products,
6 including all over-the-counter contraceptive drugs, devices, and
7 products as prescribed or as otherwise authorized under state or federal
8 law; voluntary sterilization procedures pursuant to 42 U.S.C. 18022 and
9 identified in the comprehensive guidelines supported by the health
10 resources and services administration and thereby incorporated in the
11 essential health benefits benchmark plan; patient education and coun-
12 seling on contraception; and follow-up services related to the drugs,
13 devices, products, and procedures covered under this clause, including,
14 but not limited to, management of side effects, counseling for continued
15 adherence, and device insertion and removal. Except as otherwise author-
16 ized under this clause, a contract shall not impose any restrictions or
17 delays on the coverage required under this clause. However, where the
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD09936-03-5
A. 6917--A 2
1 FDA has approved one or more therapeutic and pharmaceutical equivalent,
2 as defined by the FDA, versions of a contraceptive drug, device, or
3 product, a contract is not required to include all such therapeutic and
4 pharmaceutical equivalent versions in its formulary, so long as at least
5 one is included and covered without cost-sharing and in accordance with
6 this clause. If the covered therapeutic and pharmaceutical equivalent
7 versions of a drug, device, or product are not available or are deemed
8 medically inadvisable a contract shall provide coverage for an alternate
9 therapeutic and pharmaceutical equivalent version of the contraceptive
10 drug, device, or product without cost-sharing.
11 (a) This coverage shall include emergency contraception without cost
12 sharing when provided pursuant to a prescription, or order under section
13 sixty-eight hundred thirty-one of the education law or when lawfully
14 provided over-the-counter.
15 (b) If the attending health care provider, in [his or her] their
16 reasonable professional judgment, determines that the use of a non-cov-
17 ered therapeutic or pharmaceutical equivalent of a drug, device, or
18 product is warranted, the health care provider's determination shall be
19 final. The superintendent shall promulgate regulations establishing a
20 process, including timeframes, for an insured, an insured's designee or
21 an insured's health care provider to request coverage of a non-covered
22 contraceptive drug, device, or product. Such regulations shall include a
23 requirement that insurers use an exception form that shall meet criteria
24 established by the superintendent.
25 (c) This coverage must allow for the dispensing of up to twelve months
26 worth of a contraceptive at one time.
27 (d) This coverage shall provide for reimbursement to a pharmacist who
28 dispenses self-administered hormonal contraceptives pursuant to section
29 sixty-eight hundred one of the education law and provides related
30 services the same as any other health care provider.
31 (e) For the purposes of this clause, "over-the-counter contraceptive
32 products" shall mean those products provided for in comprehensive guide-
33 lines supported by the health resources and services administration as
34 of January twenty-first, two thousand nineteen.
35 § 2. Subparagraph (A) of paragraph 16 of subsection (l) of section
36 3221 of the insurance law, as amended by section 1 of part M of chapter
37 57 of the laws of 2019, is amended to read as follows:
38 (A) Every group or blanket policy that provides medical, major
39 medical, or similar comprehensive type coverage [that is issued,
40 amended, renewed, effective or delivered on or after January first, two
41 thousand twenty,] shall provide coverage for all of the following
42 services and contraceptive methods:
43 (1) All FDA-approved contraceptive drugs, devices, and other products.
44 This includes all FDA-approved over-the-counter contraceptive drugs,
45 devices, and products as prescribed or as otherwise authorized under
46 state or federal law. The following applies to this coverage:
47 (a) where the FDA has approved one or more therapeutic and pharmaceu-
48 tical equivalent, as defined by the FDA, versions of a contraceptive
49 drug, device, or product, a group or blanket policy is not required to
50 include all such therapeutic and pharmaceutical equivalent versions in
51 its formulary, so long as at least one is included and covered without
52 cost-sharing and in accordance with this paragraph;
53 (b) if the covered therapeutic and pharmaceutical equivalent versions
54 of a drug, device, or product are not available or are deemed medically
55 inadvisable a group or blanket policy shall provide coverage for an
56 alternate therapeutic and pharmaceutical equivalent version of the
A. 6917--A 3
1 contraceptive drug, device, or product without cost-sharing. If the
2 attending health care provider, in [his or her] their reasonable profes-
3 sional judgment, determines that the use of a non-covered therapeutic or
4 pharmaceutical equivalent of a drug, device, or product is warranted,
5 the health care provider's determination shall be final. The superinten-
6 dent shall promulgate regulations establishing a process, including
7 timeframes, for an insured, an insured's designee or an insured's health
8 care provider to request coverage of a non-covered contraceptive drug,
9 device, or product. Such regulations shall include a requirement that
10 insurers use an exception form that shall meet criteria established by
11 the superintendent;
12 (c) this coverage shall include emergency contraception without cost-
13 sharing when provided pursuant to a prescription or order under section
14 sixty-eight hundred thirty-one of the education law or when lawfully
15 provided over the counter; [and]
16 (d) this coverage must allow for the dispensing of up to twelve months
17 worth of a contraceptive at one time; and
18 (e) this coverage shall provide for reimbursement to a pharmacist who
19 dispenses self-administered hormonal contraceptives pursuant to section
20 sixty-eight hundred one of the education law and provides related
21 services the same as any other health care provider;
22 (2) Voluntary sterilization procedures pursuant to 42 U.S.C. 18022 and
23 identified in the comprehensive guidelines supported by the health
24 resources and services administration and thereby incorporated in the
25 essential health benefits benchmark plan;
26 (3) Patient education and counseling on contraception; and
27 (4) Follow-up services related to the drugs, devices, products, and
28 procedures covered under this paragraph, including, but not limited to,
29 management of side effects, counseling for continued adherence, and
30 device insertion and removal.
31 § 3. The opening paragraph and subparagraph (A) of paragraph 1 of
32 subsection (cc) of section 4303 of the insurance law, as amended by
33 section 2 of part M of chapter 57 of the laws of 2019, are amended to
34 read as follows:
35 Every contract that provides medical, major medical, or similar
36 comprehensive type coverage [that is issued, amended, renewed, effective
37 or delivered on or after January first, two thousand twenty,] shall
38 provide coverage for all of the following services and contraceptive
39 methods:
40 (A) All FDA-approved contraceptive drugs, devices, and other products.
41 This includes all FDA-approved over-the-counter contraceptive drugs,
42 devices, and products as prescribed or as otherwise authorized under
43 state or federal law. The following applies to this coverage:
44 (i) where the FDA has approved one or more therapeutic and pharmaceu-
45 tical equivalent, as defined by the FDA, versions of a contraceptive
46 drug, device, or product, a contract is not required to include all such
47 therapeutic and pharmaceutical equivalent versions in its formulary, so
48 long as at least one is included and covered without cost-sharing and in
49 accordance with this subsection;
50 (ii) if the covered therapeutic and pharmaceutical equivalent versions
51 of a drug, device, or product are not available or are deemed medically
52 inadvisable a contract shall provide coverage for an alternate therapeu-
53 tic and pharmaceutical equivalent version of the contraceptive drug,
54 device, or product without cost-sharing. If the attending health care
55 provider, in [his or her] their reasonable professional judgment, deter-
56 mines that the use of a non-covered therapeutic or pharmaceutical equiv-
A. 6917--A 4
1 alent of a drug, device, or product is warranted, the health care
2 provider's determination shall be final. The superintendent shall
3 promulgate regulations establishing a process, including timeframes, for
4 an insured, an insured's designee or an insured's health care provider
5 to request coverage of a non-covered contraceptive drug, device, or
6 product. Such regulations shall include a requirement that insurers use
7 an exception form that shall meet criteria established by the super-
8 intendent;
9 (iii) this coverage shall include emergency contraception without
10 cost-sharing when provided pursuant to a prescription or order under
11 section sixty-eight hundred thirty-one of the education law or when
12 lawfully provided over the counter; [and]
13 (iv) this coverage must allow for the dispensing of up to twelve
14 months worth of a contraceptive at one time; and
15 (v) this coverage shall include reimbursement to a pharmacist who
16 dispenses self-administered hormonal contraceptives pursuant to section
17 sixty-eight hundred one of the education law and provides related
18 services the same as any other health care provider;
19 § 4. This act shall take effect immediately and shall apply to poli-
20 cies and contracts issued, renewed, modified, altered or amended on and
21 after such date.
