Relates to prescription drug formulary coverage for interchangeable biologics and biosimilars.
Summary
A03973 amends New York insurance law to expand existing prescription drug formulary rules to explicitly include interchangeable biologics and biosimilars. Under the bill, when an insured is stable on a medication selected by a health care professional, a utilization review agent may still require step therapy with an AB-rated generic equivalent, an interchangeable biological product, or a biosimilar before covering the brand-name drug or reference product. The bill also updates formulary tiering provisions so insurers and corporations may move a drug to a higher-cost tier if a generic equivalent, interchangeable biological product, or biosimilar is added to the formulary at the same time.
The measure makes conforming changes to sections 4903, 3242, and 4329 of the insurance law and reletters existing subsections to accommodate the new language. It applies to both insurers and nonprofit health corporations with multi-tier formularies and takes effect immediately upon enactment.
Impact
The bill would broaden and clarify New York’s insurance coverage and formulary management rules by treating interchangeable biologics and biosimilars similarly to AB-rated generic equivalents for purposes of step therapy and tier placement. It affects utilization review practices, prescription drug coverage decisions, and cost-sharing structures for insured patients, while also updating statutory references in the insurance law to reflect the new categories of drugs.
Sentiment
The available voting history shows strong support and no recorded opposition in committee, with unanimous favorable votes in the Assembly Ways and Means Committee. No committee transcript is available, but the bill’s progression suggests it was viewed as a technical and policy update consistent with existing drug substitution and formulary practices.
Contention
No explicit controversy is reflected in the available materials. The main policy issue is whether insurers should be permitted to require patients to try lower-cost interchangeable biologics or biosimilars before covering brand-name drugs, and whether drugs can be shifted to higher-cost tiers when those alternatives are added. Support appears to favor cost containment and formulary flexibility, while any opposition would likely come from patients, prescribers, or brand-name drug interests concerned about access and treatment stability.