Creates the health insurance guaranty fund. To protect consumers and providers from the failure of a health insurer to perform its contractual obligations due to financial impairment or insolvency.

Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.

Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.

Provides that the New York state health care quality and cost containment commission shall: evaluate each mandated benefit; investigate current practices of health plans with regard to the mandated benefit; investigate the potential premium impact of repealing and/or modifying the mandated benefits on all segments of the insurance market; hold at least two public hearings; and submit a report to the legislature; makes related provisions.

Provides that the New York state health care quality and cost containment commission shall: evaluate each mandated benefit; investigate current practices of health plans with regard to the mandated benefit; investigate the potential premium impact of repealing and/or modifying the mandated benefits on all segments of the insurance market; hold at least two public hearings; and submit a report to the legislature; makes related provisions.

Relates to brand-name drugs with and without an AB generic equivalent; amends the effective date from January to July next succeeding the date on which it shall have become a law. Sections 1-3 provide that the requirement for insurance companies and pharmacy benefit managers to apply third-party payments or other price reduction instruments for out-of-pocket expenses made on behalf of an insured person when calculating the insured individual’s overall contribution shall apply to prescription drugs that are either: a brand-name drug without an AB rated generic equivalent, a brand-name drug with an AB rated generic equivalent and the insured has access to the brand name drug through prior authorization or through the insurers appeal process, or a generic drug the insurer will cover with or without prior authorization or an appeals process.