BILL NUMBER: S1350
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the insurance law, in relation to calculating an insured
individual's overall contribution to any out-of-pocket maximum or any
cost-sharing requirement; and to amend a chapter of the laws of 2022
amending the insurance law relating to calculating an insured individ-
ual's overall contribution to any out-of-pocket maximum or any cost-
sharing requirement, as proposed in legislative bills numbers S. 5299-A
and A. 1741-A, in relation to the effectiveness thereof
 
PURPOSE:
This is a chapter amendment that makes changes to provisions of L.2022,
c.736, to clarify provisions relating to calculating an insured individ-
ual's overall contribution to any out-of-pocket maximum or any cost-
sharing requirement
 
SUMMARY OF PROVISIONS:
The underlying chapter requires health plans and pharmacy benefit manag-
ers to count manufacturers' discounts towards a person's cost-sharing
maximum calculation. The changes limit the application of the copay
accumulator to brand-name drugs without a generic equivalent; or with a
generic equivalent that are accessed through prior authorization or
appeals; and all generic drugs.
 
EXISTING LAW:
None
 
JUSTIFICATION:
This legislation is a negotiated change to the underlying chapter.
 
LEGISLATIVE HISTORY:
Chapter amendment to Chapter 736 of the Laws of 2022. S. 5299-A and
A.1741-A both passed the Senate and Assembly in May 2022.
 
FISCAL IMPLICATIONS:
None
 
EFFECTIVE DATE:
This act shall take effect immediately; provided, however, that sections
one, two and three of this act shall take effect on the same date and in
the same manner as a chapter of the laws of 2022 amending the insurance
law relating to calculating an insured individual's overall contribution
to any out-of-pocket maximum or any cost-sharing requirement, as
proposed in legislative bills numbers S. 5299-A and