N.Y. Ins. Law § 4909

* § 4909. Prescription drug formulary changes. (a) Except as otherwise\nprovided in subsection (c) of this section, a health care plan shall\nnot:\n (i) remove a prescription drug from a formulary;\n (ii) move a prescription drug to a tier with a larger deductible,\ncopayment, or coinsurance if the formulary includes two or more tiers of\nbenefits providing for different deductibles, copayments or coinsurance\napplicable to the prescription drugs in each tier; or\n (iii) add utilization management restrictions to a prescription drug\non a formulary, unless such changes occur at the time of enrollment or\nissuance of coverage.\n (b) Prohibitions provided in subsection (a) of this section shall\napply beginning on the date on which open enrollment begins for a plan\nyear and through the end of the plan year to which such open enrollment\nperiod applies.\n (c) (i) A health care plan with a formulary that includes two or more\ntiers of benefits providing for different deductibles, copayments or\ncoinsurance applicable to prescription drugs in each tier may move a\nprescription drug to a tier with a larger deductible, copayment or\ncoinsurance if an AB-rated generic equivalent or interchangeable\nbiological product for such prescription drug is added to the formulary\nat the same time.\n (ii) A health care plan may remove a prescription drug from a\nformulary if the federal Food and Drug Administration determines that\nsuch prescription drug should be removed from the market, including new\nutilization management restrictions issued pursuant to federal Food and\nDrug Administration safety concerns.\n (iii) A health care plan with a formulary that includes two or more\ntiers of benefits providing for different copayments applicable to\nprescription drugs may move a prescription drug to a tier with a larger\ncopayment during the plan year, provided the change is not applicable to\nan insured who is already receiving such prescription drug or has been\ndiagnosed with or presented with a condition on or prior to the start of\nthe plan year which is treated by such prescription drug or is a\nprescription drug that is or would be part of the insured's treatment\nregimen for such condition.\n (d) A health care plan shall provide notice to policyholders of the\nintent to remove a prescription drug from a formulary or alter\ndeductible, copayment or coinsurance requirements in the upcoming plan\nyear, thirty days prior to the open enrollment period for the\nconsecutive plan year. Such notice of impending formulary and\ndeductible, copayment or coinsurance changes shall also be posted on the\nplan's online formulary and in any prescription drug finder system that\nthe plan provides to the public.\n (e) The provisions of this section shall not supersede the terms of a\ncollective bargaining agreement, or the rights of labor representation\ngroups to collectively bargain changes to the formularies.\n * NB Effective February 20, 2022\n