Requires that medicaid and health insurance plans provide coverage for costs of prescription smoking cessation treatment that is ordered by a physician; establishes a coverage limit for each covered individual.
Summary
S00556 would require certain New York health insurance policies and contracts to cover FDA-approved smoking cessation medications and physician-ordered counseling. The bill applies to hospital service corporations, health service corporations, individual policies, and group or blanket policies that provide hospital, surgical, or medical coverage. Coverage would include up to two quit attempts per year, with each attempt consisting of up to 90 days of medication and four counseling sessions, and the services would be provided without cost-sharing or prior authorization.
The bill also sets implementation rules for when the mandate would take effect and applies it to policies and contracts issued, renewed, modified, altered, or amended on or after the effective date. It preserves existing coverage by stating that the new mandate may not replace, restrict, or eliminate benefits already provided under a policy. Certain multi-state or collectively bargained contracts are excluded from the mandate, and the superintendent may allow deductibles and coinsurance consistent with other benefits in the policy.
Impact
If enacted, the bill would amend multiple sections of the Insurance Law to create a new statewide coverage mandate for smoking cessation treatment. It would expand required benefits in commercial health insurance by compelling coverage for FDA-approved cessation medications and counseling ordered by a physician, while limiting the benefit to two quit attempts per year. The bill would affect insurers, hospital service corporations, health service corporations, policyholders, and insured individuals seeking smoking cessation treatment, and would require regulatory implementation by the Department of Financial Services.
Sentiment
Based on the bill text and available context, the measure appears to be framed as a public health and preventive care initiative with no recorded committee debate or votes in the provided materials. The structure of the bill suggests a policy goal of improving access to smoking cessation treatment and reducing barriers such as prior authorization and cost-sharing. Because no transcript or vote history is available, there is no documented opposition or support in the supplied record beyond the bill’s introduction and referral.
Contention
The main policy questions raised by the bill are the cost and scope of the insurance mandate, including whether insurers should be required to cover medications and counseling without prior authorization or cost-sharing. Another point of potential contention is the bill’s limit of two quit attempts per year and the exclusion for certain multi-state or collectively bargained plans, which may be viewed as necessary carveouts by insurers and employers but as gaps in coverage by advocates. The bill also leaves some discretion to the superintendent regarding deductibles and coinsurance, which could be a point of debate over how robust the benefit should be in practice.
Requires that medicaid and health insurance plans provide coverage for costs of prescription smoking cessation treatment that is ordered by a physician; establishes a coverage limit for each covered individual.
Amends the law on drug coverage to require insurance plans that provide coverage for prescription drugs to offer two options for prescription delivery.