Healthcare (Prescription Drugs)

in committee · New York · Senate Jan 7, 2026

S 396: Relates to investigating critical prescription drug pricing

Requires investigating of critical prescription drug pricing; provides for civil penalties and private actions for certain critical prescription drug pricing.

Topics ✓ HealthcareSupports HealthcareInvestigates critical drug pricing to address high costs, improving patient access to medications - a core healthcare access issue.95% confidence

Sub-Topics Prescription Drugs

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in committee · New York · Assembly Jan 7, 2026

A 2650: Limits the substitution of abuse-deterrent analgesic opioid drug products for analgesic opioids lacking such technology

This bill requires health insurance plans to cover at least one abuse-deterrent opioid painkiller for each active ingredient, ensuring patients can access these FDA-approved options without higher out-of-pocket costs. It prohibits insurers from forcing patients to try non-abuse-deterrent opioids first for prior authorization or coverage approval. The law mandates that cost-sharing (like copays) for abuse-deterrent opioids must match the lowest level applied to non-abuse-deterrent versions. It directly affects patients prescribed opioid painkillers and insurance plans, aiming to improve access to formulations designed to reduce misuse.

Topics ✓ HealthcareSupports HealthcareRequires insurance coverage for abuse-deterrent opioids without higher costs, improving patient access to safer pain management options.95% confidence

Sub-Topics Insurance Prescription Drugs Substance Abuse

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in committee · New York · Senate Apr 20, 2026

S 868: Requires certain health insurance policies to include coverage for the cost of certain infant and baby formulas

Bill S 868 requires most health insurance plans covering prescription drugs to include coverage for medically necessary infant and baby formulas. It directly affects insured individuals with specific medical conditions like metabolic disorders, severe allergies, Crohn's disease, or gastrointestinal motility issues, as determined by a physician's written order. The bill mandates that coverage must be provided for formulas proven effective for these conditions (including amino acid-based or modified solid foods), with a minimum annual coverage of $3,000 per person. It distinguishes required medical formulas from elective nutritional supplements and applies to policies already covering prescription drugs.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for medically necessary infant formulas, expanding access for patients with specific conditions like metabolic disorders and allergies.95% confidence

Sub-Topics Children's Health Insurance Prescription Drugs

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in committee · New York · Senate Jan 7, 2026

S 6675: Requires insurance coverage for the cost of donated breast milk

This bill requires health insurance policies covering prescription drugs to also cover the cost of donated breast milk. It directly affects individuals, particularly mothers and infants in medical settings (like NICUs), who rely on donated breast milk but previously faced coverage gaps. The law amends specific sections of the insurance code to mandate this coverage inclusion in all relevant policies, effective immediately. The change applies to standard prescription drug coverage, not separate health plans.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for donated breast milk, expanding access to critical healthcare for infants and mothers in medical settings like NICUs.95% confidence

Sub-Topics Insurance Prescription Drugs

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in committee · New York · Assembly Jan 7, 2026

A 5282: Relates to access to appropriate drugs at reasonable prices, formulary exceptions, standing prior authorizations and external appeals

Relates to access to appropriate drugs at reasonable prices, formulary exceptions, standing prior authorizations and external appeals; to access to retail pharmacies, prescription synchronization, limits on patient drug costs, explanations of benefits and rebates; to prescription drug synchronization; to pharmacy benefit management; and to limits on copayments and drug substitutions.

Topics ✓ HealthcareSupports HealthcareBill mandates reasonable drug prices, limits patient costs, expands access via formulary exceptions, and restricts excessive copays - directly improving patient access and affordability per healthcare support indicators.92% confidence

Sub-Topics Insurance Prescription Drugs

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in committee · New York · Senate Jan 7, 2026

S 5314: Establishes patient safety and quality assurance measures regarding the distribution of patient-specific medication from an insurer-designated pharmacy

Establishes patient safety and quality assurance measures regarding the distribution of patient-specific medication from an insurer-designated pharmacy; prohibits certain "brown bagging" and "white bagging" policies regarding pharmacy provided medications.

Topics ✓ HealthcareSupports HealthcareProhibits insurer policies restricting medication access (brown/white bagging), enhancing patient safety and access to prescribed medications.95% confidence

Sub-Topics Insurance Prescription Drugs

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in committee · New York · Senate Jun 13, 2025

S 7297: Relates to utilization review program standards and pre-authorization for certain health care services

Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.

Topics ✓ HealthcareSupports HealthcareRequires evidence-based clinical criteria for utilization review/pre-authorization, standardizing care access and preventing arbitrary denials, aligning with improved patient access indicators.85% confidence

Sub-Topics Prescription Drugs

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in committee · New York · Assembly May 7, 2026

A 3973: Relates to prescription drug formulary coverage for interchangeable biologics and biosimilars

This bill updates New York insurance law to expand the types of lower-cost alternatives insurers can require patients to try before covering brand-name drugs. Specifically, it adds "interchangeable biologics" and "biosimilars" to the list of alternatives (alongside generic drugs) that insurers may mandate patients attempt first. It also allows insurers to move drugs to higher-cost coverage tiers only when adding these lower-cost alternatives to their formulary. These changes directly affect patients needing prescription drugs and insurers managing drug coverage tiers. The bill focuses on standardizing formulary rules for complex biologic medications without specifying cost outcomes.

Topics ✓ HealthcareSupports HealthcareBill mandates insurers to require lower-cost interchangeable biologics/biosimilars before brand-name drugs, reducing patient costs and improving access to affordable medications per insurance coverage policy.95% confidence

Sub-Topics Prescription Drugs

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in committee · New York · Assembly Jan 15, 2026

A 6278: Relates to electronic notification when prior authorization is required to fill a prescription

This bill requires health insurers to provide electronic notifications to insured patients when prior authorization is needed for a prescription, if the patient requests it. It directly affects patients filling prescriptions that require insurer approval, allowing them to opt for electronic alerts within 30 days of a prior authorization request. The key provision adds a new requirement for insurers to facilitate this electronic notification system, building on existing disclosure rules about in-network providers and out-of-network costs. The bill does not change prior authorization rules but streamlines communication for patients. (Summary based on bill text sections 1, 2, and 3.)

Topics ✓ HealthcareSupports HealthcareRequires insurers to provide electronic prior authorization notifications to patients, improving prescription access transparency and reducing delays in medication access.85% confidence

Sub-Topics Prescription Drugs

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in committee · New York · Senate Jun 10, 2025

S 1804: Requires insurance coverage for certain inhalers at no cost

S 1804 requires health insurance plans in New York to cover one rescue inhaler and one maintenance inhaler for asthma treatment at no cost to the patient, eliminating deductibles, copays, or coinsurance. This applies to all comprehensive health insurance policies (including major medical, group, and health service corporation plans) that cover prescription drugs. The law specifically mandates coverage for inhalers prescribed by a physician or licensed provider, with a limited exception for high-deductible plans that would otherwise disqualify enrollees from health savings accounts. The bill takes effect January 1, 2027, for all new or renewed policies after that date. It directly affects New Yorkers with asthma who rely on insurance for inhaler access.

Topics ✓ HealthcareSupports HealthcareMandates no-cost coverage for asthma inhalers, removing financial barriers to essential medication access under insurance plans.95% confidence

Sub-Topics Prescription Drugs

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