New York Senate Bill S09497

New York 2025-2026 Regular Session

• Introduced: 3/18/26
• Refer: 3/18/26
• Report Pass: 4/20/26

Caption

Requires insurers to cover the substitution of a brand name prescription drug when the federal food and drug administration has declared that there is a supply issue with a generic drug.

Summary

This bill amends the New York Insurance Law to require certain health insurers and related corporations to cover a brand-name prescription drug when a covered generic equivalent or interchangeable biological product is unavailable because of a federally recognized supply issue. The requirement applies only when the generic or interchangeable product is already in the insurer’s formulary, the FDA has identified a shortage or meaningful disruption, and the dosage cannot be adjusted to avoid the problem. The bill defines key terms such as “eligible prescription drug,” “generic drug,” and “supply issue” by reference to federal drug law. It applies when an insured is already taking the drug as a generic equivalent, or when the drug is needed to treat a condition diagnosed before the start of the plan year. In those cases, the brand-name drug must be covered at the same level as the generic until the shortage is resolved and the FDA removes the drug from its shortage list. The act takes effect immediately.

Impact

The bill would create a new insurance coverage mandate in Sections 3242 and 4329 of the Insurance Law, affecting insurers and corporations that issue prescription drug coverage in New York. It would require plans to temporarily substitute and pay for brand-name drugs at generic cost-sharing levels during FDA-recognized shortages of the generic equivalent or interchangeable biological product, potentially increasing short-term drug spending for carriers while preserving access for patients. The measure ties state coverage obligations to federal shortage determinations and would directly affect insured patients who rely on medications with disrupted supply chains.

Sentiment

The available voting history suggests strong support for the bill, with the Senate Insurance Committee approving it unanimously by an 11-0 vote. No committee transcript is available, but the structure of the bill indicates a consumer-access and continuity-of-care rationale, which typically draws favorable treatment in committee. The lack of recorded opposition in the available materials suggests the proposal was viewed as a targeted response to drug shortage problems rather than a broad expansion of coverage.

Contention

The main policy issue is the balance between ensuring uninterrupted access to needed medication and imposing a coverage mandate on insurers when a cheaper generic is unavailable. Insurers may be concerned about cost, administrative complexity, and the need to verify FDA-recognized shortages and eligibility conditions, while patient advocates and providers are likely to support the bill as a way to avoid treatment disruption. Another possible point of contention is the bill’s narrow trigger—coverage is required only when dosage cannot be adjusted and the shortage is formally recognized—meaning some stakeholders may argue it is either too limited or, conversely, too expansive depending on their perspective.