A. 2969/S. 2849 Requiring Stable Drug Formularies

Posted May 1, 2019 by Amanda Dunker

Memorandum in Support of A.2969/S.2849

Health Care for All New York (HCFANY) is a statewide coalition of over 170 organizations dedicated to achieving quality, affordable health coverage for all New Yorkers. HCFANY strongly supports A.2969/S.2849. This bill would prohibit health plans from changing drug formularies mid-contract year unless a generic equivalent becomes available. Prohibited changes include dropping drugs, altering cost-sharing responsibilities, and adding new utilization review requirements. The bill makes an exception for the release of new generic drugs, a situation in which both the consumer and the plan might benefit from lower drug costs. But it would require plans to notify members in a timely manner so that they can take any action needed to avoid a gap in care.

A. 2969/S. 2849 addresses a major challenge for insured consumers by requiring stable drug formularies. People often enroll in health plans based on the formularies posted by carriers during open enrollment. But insurers often make major changes to their drug coverage after consumers are locked into a health plan. Consumers typically find out that their drug has been dropped when they are at the pharmacist.

New Yorkers need help affording prescription drugs. Nearly half of New Yorkers say they cannot afford basic medical care including filling prescriptions.[1] This is especially alarming because most of the people surveyed are insured. Other researchers have found that cost reduces medication adherence for people with conditions like heart disease and diabetes, even for insured patients.[2]

For those reasons HCFANY strongly urges the enactment of this bill.

[1] Altarum Healthcare Value Hub, New Yorkers Struggle to Afford High Healthcare Costs; Support a Range of Government Solutions Across Party Lines, Data Brief No. 37, March 2019, https://www.healthcarevaluehub.org/advocate-resources/publications/new-yorkers-struggle-afford-high-healthcare-costs-support-range-government-solutions-across-party-lines/.

[2] Rohan Khera et al., “Abstract 12916: Cost-Related Medication Non-Adherence in Nonelderly with Atherosclerotic Cardiovascular Disease in the United States, 2013-2016, Circulation, 2018, 138:A12916, https://www.ahajournals.org/doi/abs/10.1161/circ.138.suppl_1.12916; Andrew Karter et al., “Effect of Out-of-Pocket Cost on Medication Initiation, Adherence, and Persistence among Patients with Type 2 Diabetes: The Diabetes Study of Northern California,” Health Services Research, 5 May 2017, 53:2 (1227-1247),