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A09055 Summary:

BILL NOA09055
 
SAME ASSAME AS S07768
 
SPONSORMcDonald
 
COSPNSRO'Donnell
 
MLTSPNSR
 
Amd §§4903, 3242 & 4329, Ins L
 
Relates to prescription drug formulary coverage for interchangeable biologics and biosimilars.
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A09055 Actions:

BILL NOA09055
 
02/05/2024referred to insurance
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A09055 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A9055
 
SPONSOR: McDonald
  TITLE OF BILL: An act to amend the insurance law, in relation to prescription drug formulary coverage for interchangeable biologics and biosimilars   PURPOSE: To reduce prescription drug costs in New York by allowing biosimilar medicines to be substituted for the original biologics.   SUMMARY OF PROVISIONS: Section one amends section 4903 of the Insurance law to add both inter- changeable biologics and biosimilars to New York's step therapy proto- col, allowing utilization review agents to require an insured to try an interchangeable biologic or biosimilar medication before covering the name brand drug. Section two amends section 3242 of the Insurance law to allow insurance companies to move a reference drug to a tier with a larger deductible, copayment, or coinsurance if a biosimilar version of that drug exists and is added to the formulary at the same time. Section three amends section 4329 of the Insurance law to allow non-pro- fit insurance companies to move a reference drug to a tier with a. larg- er deductible, copayment, or coinsurance if a biosimilar version of that drug exists and is added to the formulary at the same time.   JUSTIFICATION: Biological medications or 'biologics' are on the cutting edge of medical technology and are used to treat complicated conditions and diseases including cancer, rheumatoid arthritis, diabetes and multiple sclerosis. These drugs are often life-changing and life-saving, but they are also delicate and complicated to produce. Biologics are made using living organisms that produce the proteins required to make the medication. This process makes these medications incredibly cost prohibitive for companies to develop and test, resulting in high costs to patients and insurance companies. However, alternative versions of biologics called 'biosimilars' have been developed. Biosimilars are an FDA-approved drug that is similar to an existing biologic medication (or reference drug) and produces the same outcome. Biosimilars are produced by manufacturers who did not develop the original biologic. Because these manufacturers did not have to finance the extensive costs associated with biologic development, they can sell the medication at a lower cost. In addition, biosimilars undergo an abbreviated FDA approval process because the reference biologic has demonstrated the medication's effectiveness. This shorter proceeding further reduces development costs for biosimilar manufactur- ers and contributes to lower biosimilar prices.' This bill would amend New York State's insurance law to allow insurance providers to require their insureds to try a biosimilar medication instead of the reference drug and place a biosimilar in a less expensive tier of prescription medication. This would generate cost savings for both the patient and the insurance company, making access to medication more affordable.   LEGISLATIVE HISTORY: New Bill.   FISCAL IMPLICATIONS: To be determined.   EFFECTIVE DATE: This act shall take effect immediately.
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A09055 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          9055
 
                   IN ASSEMBLY
 
                                    February 5, 2024
                                       ___________
 
        Introduced by M. of A. McDONALD -- read once and referred to the Commit-
          tee on Insurance
 
        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, an
     8  interchangeable biological product , or biosimilar  prior  to  providing
     9  coverage for the equivalent brand name prescription drug or drugs; or
    10    § 2. Subparagraph (A) of paragraph 3 of subsection (c) of section 3242
    11  of  the  insurance  law,  as added by chapter 99 of the laws of 2022, is
    12  amended to read as follows:
    13    (A) An insurer with a formulary that includes two  or  more  tiers  of
    14  benefits  providing for different deductibles, copayments or coinsurance
    15  applicable to prescription drugs in each tier may  move  a  prescription
    16  drug  to a tier with a larger deductible, copayment or coinsurance if an
    17  AB-rated generic equivalent [or], an interchangeable biological product,
    18  or biosimilar for such prescription drug is added to  the  formulary  at
    19  the same time.
    20    §  3.    Subparagraph  (A) of paragraph 3 of subsection (c) of section
    21  4329 of the insurance law, as added by chapter 99 of the laws  of  2022,
    22  is amended to read as follows:
    23    (A)  A corporation with a formulary that includes two or more tiers of
    24  benefits providing for different deductibles, copayments or  coinsurance
    25  applicable  to  prescription  drugs in each tier may move a prescription
    26  drug to a tier with a larger deductible, copayment or coinsurance if  an
    27  AB-rated generic equivalent [or], an interchangeable biological product,
    28  or  biosimilar  for  such prescription drug is added to the formulary at
    29  the same time.
    30    § 4.  This act shall take effect immediately.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11861-01-3
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