NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A10461
SPONSOR: Rules (Simone) TITLE OF BILL:
An act to amend the insurance law, in relation to copayments of pre-ex-
posure or post-exposure prophylaxis
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill is to clarify under the insurance law that
insurers cannot impose copayments on pre-exposure prophylaxis (PrEP)
under certain circumstances.
SUMMARY OF PROVISIONS:
This bill would clarify that insurers cannot require copayments for PrEP
so as long as it has in effect a rating of 'A' or `B' in the current
recommendations of the United States Preventive Services Task Force.
JUSTIFICATION:
A copay is a fixed cost that an insurance policyholder pays for a
specific service covered by their insurance. Coinsurance, on the other
hand, is a percentage of the cost of a service. While these are two
separate forms of cost-sharing, copayments are often considered to be a
form of coinsurance under the insurance law. Currently, PrEP is not
subject to annual deductibles and coinsurance because it has an 'A'
rating with this USPSTF, however, the insurance law provides no explicit
prohibition against the use of copayments. This bill would clarify that
insurers may not impose copays on PrEP so as long as it has in effect a
rating of `A' or 'B' in the current recommendations of the United States
Preventive Services Task Force.
PRIOR LEGISLATIVE HISTORY:
New bill
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
None.
STATE OF NEW YORK
________________________________________________________________________
10461
IN ASSEMBLY
May 29, 2024
___________
Introduced by COMMITTEE ON RULES -- (at request of M. of A. Simone) --
read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to copayments of pre-ex-
posure or post-exposure prophylaxis
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 21 of subsection (l) of section 3221 of the
2 insurance law, as amended by chapter 79 of the laws of 2023, is amended
3 to read as follows:
4 (21) Every large group policy which provides medical, major medical,
5 or comprehensive-type coverage shall include coverage for the cost of
6 pre-exposure prophylaxis (PrEP) for the prevention of HIV and post-expo-
7 sure prophylaxis to prevent HIV infection. Such coverage may be subject
8 to annual deductibles [and], coinsurance, and copayments as may be
9 deemed appropriate by the superintendent and as are consistent with
10 those established for other benefits within a given policy, unless the
11 pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis has in
12 effect a rating of 'A' or 'B' in the current recommendations of the
13 United States preventive services task force.
14 § 2. Subsection (tt) of section 4303 of the insurance law, as amended
15 by chapter 79 of the laws of 2023, is amended to read as follows:
16 (tt) Every large group contract issued by a hospital services corpo-
17 ration or a health services corporation which provides medical, major
18 medical, or comprehensive-type coverage shall include coverage for the
19 cost of pre-exposure prophylaxis (PrEP) for the prevention of HIV and
20 post-exposure prophylaxis to prevent HIV infection. Such coverage may be
21 subject to annual deductibles [and], coinsurance, and copayments as may
22 be deemed appropriate by the superintendent and as are consistent with
23 those established for other benefits within a given contract, unless the
24 pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis has in
25 effect a rating of 'A' or 'B' in the current recommendations of the
26 United States preventive services task force.
27 § 3. This act shall take effect immediately and shall apply to all
28 policies and contracts issued, renewed, modified, altered or amended on
29 or after such date.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD15793-01-4
