New York Assembly Bill A05354

New York 2025-2026 Regular Session

• Introduced: 2/13/25
• Refer: 2/13/25
• Refer: 1/7/26

Caption

Requires health insurers to provide coverage without cost-sharing for opioid antagonists and devices; provides that no prior authorization of premedical review for coverage of such opioid antagonist is required.

Summary

This bill would require New York health insurance policies that cover prescription drugs to cover at least one opioid antagonist and device, such as naloxone, without any cost-sharing. It also prohibits insurers from requiring prior authorization or premedical review before covering an opioid antagonist. The mandate applies across individual, group, and blanket policies under the Insurance Law. The bill expressly includes opioid antagonists dispensed under standing orders or collaborative practice agreements, including when intended for use by someone other than the insured. For certain policies, the coverage requirement would apply to policies issued, renewed, amended, effective, or delivered on or after January 1, 2026, while the act itself would take effect immediately and apply to policies and contracts modified or renewed on or after the effective date.

Impact

The bill amends sections 3216, 3221, and 4303 of the Insurance Law to create a uniform coverage mandate for opioid antagonists and devices in health insurance products. It would bar deductibles, copayments, coinsurance, and other cost-sharing for the covered medication and device, and it would eliminate prior authorization or premedical review requirements for coverage. The practical effect is to expand access to overdose-reversal medications for insured individuals and, in some cases, for community distribution through standing orders or collaborative practice agreements.

Sentiment

The bill’s purpose and framing suggest strong public-health support, focusing on reducing barriers to access for opioid overdose reversal medications. No committee transcript or vote data is available, so there is no recorded legislative debate or roll-call sentiment in the provided materials. Based on the bill text and caption, the measure appears to be presented as a straightforward access-and-affordability mandate rather than a controversial policy change.

Contention

The main potential points of contention are insurer cost and utilization controls versus public access. Insurers may object to the prohibition on prior authorization and all cost-sharing, since those provisions remove common management tools and shift the full cost to plans. Supporters would likely emphasize that opioid antagonists are time-sensitive, life-saving medications and that barriers such as copays or prior approval can delay access. No specific opposition or amendments are shown in the provided record.