New York Senate Bill S05013

New York 2025-2026 Regular Session

• Introduced: 2/18/25
• Refer: 2/18/25
• Refer: 1/7/26

Caption

Requires health insurers to provide coverage for opioid antagonists and devices.

Summary

This bill would require New York health insurance policies that cover prescription drugs to also cover at least one opioid antagonist and associated device. The mandate applies to individual, group, and nonprofit health insurance policies by amending multiple sections of the Insurance Law, and it specifically identifies naloxone and other Department of Health-approved medications as covered opioid antagonists. The bill also makes clear that coverage must extend to products prescribed or dispensed under a standing order or collaborative practice agreement, including when intended for use by someone other than the insured. The bill allows insurers to impose prior authorization on non-generic versions of opioid antagonists and devices, and it permits annual deductibles and co-insurance so long as they are consistent with other benefits in the policy and approved by the superintendent. The measure would take effect 30 days after becoming law.

Impact

The bill would amend Insurance Law sections 3216, 3221, and 4303 to create a statewide coverage requirement for opioid antagonists in prescription drug plans. It would expand access to naloxone and similar overdose-reversal medications by making them a covered benefit across major categories of health insurance, while preserving insurer cost-sharing and utilization-management tools for certain products. The practical effect would be to reduce out-of-pocket barriers for insured individuals and potentially for third-party access through standing orders or collaborative practice agreements.

Sentiment

The available record shows no committee transcript, vote tally, or recorded opposition, so there is no documented debate in the provided materials. Based on the bill’s subject matter and its straightforward coverage mandate, the measure appears to be framed as a public health and overdose-prevention proposal rather than a controversial restructuring of insurance benefits. The absence of recorded votes or discussion prevents a more specific assessment of support or resistance.

Contention

The main policy tension in the bill is between expanding access to overdose-reversal medication and preserving insurer controls over coverage. Supporters would likely favor the mandate because it lowers barriers to naloxone and similar drugs, including for use by people other than the insured. Potential points of contention are the allowance for prior authorization on non-generic products and the continued use of deductibles and co-insurance, which may limit the practical affordability of coverage. No specific stakeholder positions are provided in the record.