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Bill

A 9519

Requires certain health insurance policies include coverage for services provided by pharmacists related to contraceptives

2025 Regular Session Introduced by Sarah Clark and 7 co-sponsors

Requires insurance plans to cover FDA-approved contraception and related services with minimal cost-sharing, including 12-month supplies and pharmacist-administered options.

SUBSTITUTED BY S8869
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WeVote Research Nonpartisan
Bill Summary · A 9519

Summary of Bill A.9519 (2025-2026) — New York

Purpose and intent

  • Establishes that certain health insurance policies must provide coverage for a broad range of contraceptive-related services and products, including pharmacist-provided services, as part of essential health benefits.
  • Aims to ensure no unreasonable coverage restrictions or delays for FDA-approved contraceptives and related services, while allowing for reasonable substitution of therapeutically equivalent products when necessary.

Key provisions and changes

Coverage scope (contraceptives and related services)

  • Mandates that health insurance policies cover:
    • All FDA-approved contraceptive drugs, devices, and other products, including over-the-counter (OTC) formulations as prescribed or authorized by law.
    • Voluntary sterilization procedures (as outlined by 42 U.S.C. 18022 and related HRSA guidelines).
    • Patient education and counseling on contraception.
    • Follow-up services related to the covered drugs, devices, products, and procedures (e.g., side-effect management, adherence counseling, device insertion/removal).
    • Emergency contraception without cost-sharing when prescribed or lawfully provided OTC.
    • Dispensing of up to 12 months of contraception at one time.
    • An administrative fee to pharmacists dispensing self-administered hormonal contraceptives (at least equal to the Medicaid rate for related services).

Formulary and non-covered alternatives

  • If multiple therapeutic/pharmacological equivalents exist, plans must cover at least one version without cost-sharing; other equivalents may not be required to be included.
  • If a covered version is unavailable or deemed medically inadvisable, plans must cover an alternate equivalent version without cost-sharing.
  • If a non-covered option is deemed warranted by the attending health care provider (in their professional judgment), the provider’s determination is final. The Department of Financial Services (the superintendent) must create a process, including timelines, to request coverage for non-covered contraceptives, and insurers must use an exception form meeting criteria set by the superintendent.

Pharmacist-related provisions

  • Creates an administrative framework to support pharmacist involvement, including:
    • An administrative fee to pharmacists dispensing self-administered hormonal contraceptives and providing related services, no less than the current Medicaid rate for the same services.

Timing and scope

  • Applies to group or blanket policies that provide medical or major medical coverage (as described below) and aligns with existing sections of the Insurance Law.
  • The bill contains parallel language in multiple sections to ensure consistency across plans and contracts.

Affected entities

  • Insurance policies and contracts that provide medical/major medical coverage, including group or blanket policies.
  • Insurers operating in New York, subject to the amended sections of the Insurance Law.
  • Pharmacists and pharmacy practice, specifically those dispensing self-administered hormonal contraceptives and providing related services.
  • Health care providers who prescribe or order contraceptives and provide related care (education, counseling, follow-up).
  • Enrollees/insured individuals who will receive contraceptives and related services with the updated coverage, including OTC contraceptives and emergency contraception when prescribed or lawfully provided OTC.

Procedural and timeline aspects

  • Commencement: The act takes effect immediately upon enactment.
  • Application: Applies to policies issued, renewed, modified, or amended on or after the effective date (immediate effect language appears in multiple sections, aligning with other parts of the Insurance Law).

Practical impact and considerations

  • Consumers may experience improved access to a wide range of contraceptives and related services with reduced or eliminated cost-sharing.
  • Access to 12-month contraceptive supplies at once could improve adherence and convenience.
  • Regulatory framework for requesting coverage of non-covered contraceptives (exception processes) introduces a formal path for providers and insured individuals to seek coverage of alternatives.
  • Pharmacist reimbursement for dispensing self-administered hormonal contraceptives aligns pharmacist services with Medicaid-like rates, potentially increasing pharmacist participation and access points.

Note: This summary reflects the bill text as introduced, including amendments proposed to sections of the Insurance Law and related education law provisions.

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

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