STATE OF NEW YORK
________________________________________________________________________
3485--A
2025-2026 Regular Sessions
IN SENATE
January 27, 2025
___________
Introduced by Sen. HINCHEY -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the insurance law, in relation to prescription drug
formulary coverage for interchangeable biologics and biosimilars
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 4 of subsection (c-1) of section 4903 of the
2 insurance law, as added by chapter 512 of the laws of 2016, is amended
3 to read as follows:
4 (4) The insured is stable on a prescription drug or drugs selected by
5 their health care professional for the medical condition under consider-
6 ation, provided that this shall not prevent a utilization review agent
7 from [requiring an insured to try an AB-rated generic equivalent prior
8 to providing coverage for the equivalent brand name prescription drug or
9 drugs; or]:
10 (i) requiring an insured to try an AB-rated generic equivalent or an
11 interchangeable biological product prior to providing coverage for the
12 equivalent brand name prescription drug or drugs, or
13 (ii) requiring an insured to try a biosimilar prior to providing
14 coverage for the brand name prescription reference product drug or
15 drugs.
16 § 2. Subparagraph (A) of paragraph 3 of subsection (c) of section 3242
17 of the insurance law, as added by chapter 99 of the laws of 2022, is
18 amended to read as follows:
19 (A) An insurer with a formulary that includes two or more tiers of
20 benefits providing for different deductibles, copayments or coinsurance
21 applicable to prescription drugs in each tier may move a prescription
22 drug to a tier with a larger deductible, copayment or coinsurance if an
23 AB-rated generic equivalent [or], an interchangeable biological product,
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD03429-04-5
S. 3485--A 2
1 or biosimilar for such prescription drug is added to the formulary at
2 the same time.
3 § 3. Subparagraph (A) of paragraph 3 of subsection (c) of section
4 4329 of the insurance law, as added by chapter 99 of the laws of 2022,
5 is amended to read as follows:
6 (A) A corporation with a formulary that includes two or more tiers of
7 benefits providing for different deductibles, copayments or coinsurance
8 applicable to prescription drugs in each tier may move a prescription
9 drug to a tier with a larger deductible, copayment or coinsurance if an
10 AB-rated generic equivalent [or], an interchangeable biological product,
11 or biosimilar for such prescription drug is added to the formulary at
12 the same time.
13 § 4. Subsection (c) of section 3242 of the insurance law, as added
14 by chapter 99 of the laws of 2022, is relettered subsection (d).
15 § 5. Subsection (c) of section 4329 of the insurance law, as added by
16 chapter 99 of the laws of 2022, is relettered subsection (d).
17 § 6. This act shall take effect immediately.
