BILL NUMBER: S9842
SPONSOR: HOYLMAN-SIGAL
 
TITLE OF BILL:
An act to amend the insurance law, in relation to copayments of pre-ex-
posure or post-exposure prophylaxis
 
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill is to clarify under the insurance law that
insurers cannot impose copayments on pre-exposure prophylaxis (PrEP)
under certain circumstances.
 
SUMMARY OF PROVISIONS:
This bill would clarify that insurers cannot require copayments for PrEP
so as long as it has in effect a rating of 'A' or 'B' in the current
recommendations of the United States Preventive Services Task Force.
 
JUSTIFICATION:
A copay is a fixed cost that an insurance policyholder pays for a
specific service covered by their insurance. Coinsurance, on the other
hand, is a percentage of the cost of a service. While these are two
separate forms of cost-sharing, copayments are often considered to be a
form of coinsurance under the insurance law. Currently, PrEP is not
subject to annual deductibles and coinsurance because it has an 'A'
rating with this USPSTF, however, the insurance law provides no explicit
prohibition against the use of copayments. This bill would clarify that
insurers may not impose copays on PrEP so as long as it has in effect a
rating of 'A' or 'B' in the current recommendations of the United States
Preventive Services Task Force.
 
PRIOR LEGISLATIVE HISTORY:
New bill
 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
None.
 
EFFECTIVE DATE:
This act shall take effect immediately and shall apply to all policies
and contracts issued, renewed, modified, altered, or amended on or after
such date.

Statutes affected:
S9842: 3221 insurance law, 3221(l) insurance law, 4303 insurance law, 4303(tt) insurance law