Healthcare (Prescription Drugs)

This bill requires health insurers to provide electronic notifications to insured patients when prior authorization is needed for a prescription, if the patient requests it. It directly affects patients filling prescriptions that require insurer approval, allowing them to opt for electronic alerts within 30 days of a prior authorization request. The key provision adds a new requirement for insurers to facilitate this electronic notification system, building on existing disclosure rules about in-network providers and out-of-network costs. The bill does not change prior authorization rules but streamlines communication for patients. (Summary based on bill text sections 1, 2, and 3.)

S 1804 requires health insurance plans in New York to cover one rescue inhaler and one maintenance inhaler for asthma treatment at no cost to the patient, eliminating deductibles, copays, or coinsurance. This applies to all comprehensive health insurance policies (including major medical, group, and health service corporation plans) that cover prescription drugs. The law specifically mandates coverage for inhalers prescribed by a physician or licensed provider, with a limited exception for high-deductible plans that would otherwise disqualify enrollees from health savings accounts. The bill takes effect January 1, 2027, for all new or renewed policies after that date. It directly affects New Yorkers with asthma who rely on insurance for inhaler access.

This bill (S 2676) sets new rules for health insurance step therapy protocols, which require patients to try lower-cost medications first before covering more expensive options. It directly affects health insurance plans and patients needing specialty medications by limiting step therapy to no more than two drugs in the same category, capping the required trial period at 30 days (or evidence-based guidelines), and requiring insurers to accept doctors' written documentation of treatment failure as proof. The bill also prevents insurers from reapplying step therapy for patients who completed it under prior coverage or for drugs previously approved by the plan. These changes take effect January 1, 2026.

Relates to preserving access to affordable drugs; provides that an agreement resolving or settling, on a final or interim basis, a patent infringement claim, in connection with the sale of a pharmaceutical product, shall be presumed to have anticompetitive effects if a nonreference drug filer receives anything of value from another company asserting patent infringement and if the nonreference drug filer agrees to limit or forego research, development, manufacturing, marketing, or sales of the nonreference drug filer's product for any period of time.

Enacts the "New York affordable drug manufacturing act" to direct the commissioner of health to enter into partnerships to increase competition, lower prices, and address shortages in the market for generic prescription drugs, to reduce the cost of prescription drugs for public and private purchasers, taxpayers, and consumers, and to increase patient access to affordable drugs.