Bill Text: NY S02128 | 2025-2026 | General Assembly | Introduced
Bill Title: Requires certain health insurance issuers to certify that at least a majority of prescription drug rebates are provided to patients at the point of sale.
Spectrum: Partisan Bill (Democrat 6-0)
Status: (Introduced) 2025-01-15 - REFERRED TO INSURANCE [S02128 Detail]
Download: New_York-2025-S02128-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 2128 2025-2026 Regular Sessions IN SENATE January 15, 2025 ___________ Introduced by Sen. JACKSON -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance AN ACT to amend the insurance law and the public health law, in relation to requiring certain health insurance issuers to certify that at least a majority of prescription drug rebates are provided to patients at the point of sale The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. The insurance law is amended by adding a new section 3246 2 to read as follows: 3 § 3246. Ensuring fairness in certain cost sharing. (a) As used in this 4 section, the following terms shall have the following meanings: 5 (1) "Defined cost sharing" means a deductible payment or coinsurance 6 amount imposed on an enrollee for a covered prescription drug under the 7 enrollee's health plan. 8 (2) "Insurer" means any health insurance issuer that is subject to 9 state law regulating insurance and offers health insurance coverage, as 10 defined in 42 U.S.C. § 300gg-91, or any state or local governmental 11 employer plan. 12 (3) "Price protection rebate" means a negotiated price concession that 13 accrues directly or indirectly to the insurer, or other party on behalf 14 of the insurer, in the event of an increase in the wholesale acquisition 15 cost of a drug above a specified threshold. 16 (4) "Rebate" means: 17 (A) Negotiated price concessions including but not limited to base 18 price concessions, whether described as a rebate or otherwise, and 19 reasonable estimates of any price protection rebates and performance- 20 based price concessions that may accrue directly or indirectly to the 21 insurer during the coverage year from a manufacturer, dispensing pharma- 22 cy, or other party in connection with the dispensing or administration 23 of a prescription drug, and EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD05948-01-5S. 2128 2 1 (B) Reasonable estimates of any negotiated price concessions, fees and 2 other administrative costs that are passed through, or are reasonably 3 anticipated to be passed through, to the insurer and serve to reduce the 4 insurer's liabilities for a prescription drug. 5 (b) An enrollee's defined cost sharing for each prescription drug 6 shall be calculated at the point of sale based on a price that is 7 reduced by an amount equal to at least eighty-five percent of all 8 rebates received, or to be received, in connection with the dispensing 9 or administration of the prescription drug. Nothing shall preclude an 10 insurer from decreasing an enrollee's defined cost sharing by an amount 11 greater than that required under this subsection. 12 (c) An insurer shall submit to the superintendent by the first of 13 January of each year a certification in a form to be established by the 14 superintendent attesting that it has complied with the requirements of 15 subsection (b) of this section for the prior calendar year. 16 (d) In complying with the provisions of this section, an insurer or 17 its agents shall not publish or otherwise publicly reveal information 18 regarding the actual amount of rebates an insurer receives on a product 19 or therapeutic class of products, manufacturer, or pharmacy-specific 20 basis. Such information shall be exempt from disclosure under section 21 eighty-seven of the public officers law and shall not be disclosed 22 directly or indirectly, or in a manner that would allow for the iden- 23 tification of an individual product, therapeutic class of products, or 24 manufacturer, or in a manner that would have the potential to compromise 25 the financial, competitive, or proprietary nature of such information. 26 An insurer shall impose the confidentiality protections of this subdivi- 27 sion on any vendor or downstream third-party that performs health care 28 or administrative services on behalf of the insurer that may receive or 29 have access to rebate information. 30 § 2. The insurance law is amended by adding a new section 4331 to read 31 as follows: 32 § 4331. Ensuring fairness in certain cost sharing. (a) As used in this 33 section, the following terms shall have the following meanings: 34 (1) "Defined cost sharing" means a deductible payment or coinsurance 35 amount imposed on an enrollee for a covered prescription drug under the 36 enrollee's health plan. 37 (2) "Corporation" means any health insurance issuer that is subject to 38 state law regulating insurance and offers health insurance coverage, as 39 defined in 42 U.S.C. § 300gg-91, or any state or local governmental 40 employer plan. 41 (3) "Price protection rebate" means a negotiated price concession that 42 accrues directly or indirectly to the corporation, or other party on 43 behalf of the corporation, in the event of an increase in the wholesale 44 acquisition cost of a drug above a specified threshold. 45 (4) "Rebate" means: 46 (A) Negotiated price concessions including but not limited to base 47 price concessions, whether described as a rebate or otherwise, and 48 reasonable estimates of any price protection rebates and performance- 49 based price concessions that may accrue directly or indirectly to the 50 corporation during the coverage year from a manufacturer, dispensing 51 pharmacy, or other party in connection with the dispensing or adminis- 52 tration of a prescription drug, and 53 (B) Reasonable estimates of any negotiated price concessions, fees and 54 other administrative costs that are passed through, or are reasonably 55 anticipated to be passed through, to the corporation and serve to reduce 56 the corporation's liabilities for a prescription drug.S. 2128 3 1 (b) An enrollee's defined cost sharing for each prescription drug 2 shall be calculated at the point of sale based on a price that is 3 reduced by an amount equal to at least eighty-five percent of all 4 rebates received, or to be received, in connection with the dispensing 5 or administration of the prescription drug. Nothing shall preclude a 6 corporation from decreasing an enrollee's defined cost sharing by an 7 amount greater than that required under this subsection. 8 (c) A corporation shall submit to the superintendent by the first of 9 January of each year a certification in a form to be established by the 10 superintendent attesting that it has complied with the requirements of 11 subsection (b) of this section for the prior calendar year. 12 (d) In complying with the provisions of this section, a corporation or 13 its agents shall not publish or otherwise publicly reveal information 14 regarding the actual amount of rebates a corporation receives on a prod- 15 uct or therapeutic class of products, manufacturer, or pharmacy-specific 16 basis. Such information shall be exempt from disclosure under section 17 eighty-seven of the public officers law and shall not be disclosed 18 directly or indirectly, or in a manner that would allow for the iden- 19 tification of an individual product, therapeutic class of products, or 20 manufacturer, or in a manner that would have the potential to compromise 21 the financial, competitive, or proprietary nature of such information. A 22 corporation shall impose the confidentiality protections of this subdi- 23 vision on any vendor or downstream third-party that performs health care 24 or administrative services on behalf of the corporation that may receive 25 or have access to rebate information. 26 § 3. The public health law is amended by adding a new section 4417 to 27 read as follows: 28 § 4417. Ensuring fairness in certain cost sharing. 1. As used in this 29 section, the following terms shall have the following meanings: 30 (a) "Defined cost sharing" means a deductible payment or coinsurance 31 amount imposed on an enrollee for a covered prescription drug under the 32 enrollee's health plan. 33 (b) "Organization" means any health insurance issuer that is subject 34 to state law regulating insurance and offers health insurance coverage, 35 as defined in 42 U.S.C. § 300gg-91, or any state or local governmental 36 employer plan. 37 (c) "Price protection rebate" means a negotiated price concession that 38 accrues directly or indirectly to the organization, or other party on 39 behalf of the organization, in the event of an increase in the wholesale 40 acquisition cost of a drug above a specified threshold. 41 (d) "Rebate" means: 42 (i) Negotiated price concessions including but not limited to base 43 price concessions, whether described as a rebate or otherwise, and 44 reasonable estimates of any price protection rebates and performance- 45 based price concessions that may accrue directly or indirectly to the 46 organization during the coverage year from a manufacturer, dispensing 47 pharmacy, or other party in connection with the dispensing or adminis- 48 tration of a prescription drug, and 49 (ii) Reasonable estimates of any negotiated price concessions, fees 50 and other administrative costs that are passed through, or are reason- 51 ably anticipated to be passed through, to the organization and serve to 52 reduce the organization's liabilities for a prescription drug. 53 2. An enrollee's defined cost sharing for each prescription drug shall 54 be calculated at the point of sale based on a price that is reduced by 55 an amount equal to at least eighty-five percent of all rebates received, 56 or to be received, in connection with the dispensing or administrationS. 2128 4 1 of the prescription drug. Nothing shall preclude an organization from 2 decreasing an enrollee's defined cost sharing by an amount greater than 3 that required under this subdivision. 4 3. An organization shall submit to the superintendent by the first of 5 January of each year a certification in a form to be established by the 6 superintendent attesting that it has complied with the requirements of 7 subdivision two of this section for the prior calendar year. 8 4. In complying with the provisions of this section, an organization 9 or its agents shall not publish or otherwise publicly reveal information 10 regarding the actual amount of rebates an organization receives on a 11 product or therapeutic class of products, manufacturer, or pharmacy-spe- 12 cific basis. Such information shall be exempt from disclosure under 13 section eighty-seven of the public officers law and shall not be 14 disclosed directly or indirectly, or in a manner that would allow for 15 the identification of an individual product, therapeutic class of 16 products, or manufacturer, or in a manner that would have the potential 17 to compromise the financial, competitive, or proprietary nature of such 18 information. An organization shall impose the confidentiality 19 protections of this subdivision on any vendor or downstream third-party 20 that performs health care or administrative services on behalf of the 21 organization that may receive or have access to rebate information. 22 § 4. This act shall take effect immediately and apply to contracts 23 issued, renewed or amended on or after January 1, 2025.
