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Bill

S 6925

Relates to capping cost sharing for antiviral COVID-19 therapeutics

2025 Regular Session Introduced by Brad Hoylman-Sigal

Caps patient cost sharing for antiviral COVID-19 therapies to lower out-of-pocket costs and expand access for insured individuals, reshaping insurer and PBMs spending.

REFERRED TO INSURANCE
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Bill Summary · S 6925

Summary: Bill S 6925 — Relates to capping cost sharing for antiviral COVID-19 therapeutics

Quick Overview

  • Bill Number: S 6925
  • Title: Relates to capping cost sharing for antiviral COVID-19 therapeutics
  • Status: REFERRED TO INSURANCE
  • Introduced: March 27, 2025
  • Classification: bill
  • Sponsor: Brad Hoylman-Sigal (primary)
  • Related Bills: S 8367 (prior-session); A 3833 (companion)

Purpose and Intent

The bill aims to reduce or eliminate out-of-pocket costs for patients receiving antiviral treatments for COVID-19 by establishing a cap on cost sharing. While the full text is not provided here, the title indicates a consumer-protection objective to improve access to antiviral therapies during the pandemic or post-pandemic period when such treatments are utilized.

Key Provisions (Based on Title and typical structure)

  • Establishment of a cap on patient cost sharing for antiviral COVID-19 therapeutics (e.g., copays, coinsurance, deductibles) across applicable plans.
  • Definitions clarifying which antiviral therapies are covered under the cap and which therapies qualify as “antiviral COVID-19 therapeutics.”
  • Scope of application likely to include health insurance policies and plans regulated by the state’s insurance regulator; specifics would be spelled out in the bill’s text.
  • Provisions on enforcement, penalties for non-compliance, and responsibilities of insurers, health plans, and possibly pharmacy benefit managers.
  • Implementation timeline and any phase-in requirements, transitional rules, or exemptions (e.g., certain plans or populations) to be detailed in the final text.

Note: The exact dollar amounts, caps, eligible therapies, and detailed operational rules are not included in the information provided. The final text would specify these specifics.

Affected Parties

  • Individuals insured under applicable health plans who may seek antiviral COVID-19 therapeutics.
  • Health insurers and health plans regulated by the state’s insurance department.
  • Pharmacy benefit managers (PBMs) and healthcare providers involved in dispensing or administering antiviral therapies.
  • Pharmaceutical manufacturers of antiviral COVID-19 therapies (indirectly, through price and coverage dynamics).

Legislative Process and Timeline

  • Introduced and immediately referred to the Senate Insurance Committee on March 27, 2025.
  • The bill’s progress will depend on committee consideration, potential amendments, and subsequent votes on the Senate floor. If advanced, it may proceed to the other legislative chamber per normal protocol.
  • Related legislation exists in companion forms (A 3833) and prior-session S 8367, indicating ongoing interest in this policy area.

Potential Impact

  • If enacted, the cap could reduce out-of-pocket costs for patients needing antiviral COVID-19 treatment, potentially improving access and adherence.
  • Insurers and PBMs may experience changes in cost-sharing design and overall spending on antiviral therapies.
  • The net effect on system costs would depend on the cap amount, the universe of eligible therapies, and any offsetting measures in the bill.

Next Steps for Readers

  • Monitor committee actions on the Insurance committee for hearings and amendments.
  • Review the final bill text (when available) for precise definitions, caps, applicability, and transition rules.
  • Consider related companion bills (A 3833) for parallel provisions and potential differences across chambers.

Compiled from official sources — confirm details with the bill’s official record.

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