Bill Text: NY A06059 | 2023-2024 | General Assembly | Amended
Bill Title: Prohibits health insurers, health care plans and HMOs from requiring prior authorization for pre-exposure prophylaxis used to prevent HIV infection, provided that the health insurer, health care plan or HMO can confirm that the insured prescribed pre-exposure prophylaxis has tested negative for HIV within the previous one hundred and twenty days.
Spectrum: Partisan Bill (Democrat 25-1)
Status: (Introduced) 2024-05-17 - print number 6059c [A06059 Detail]
Download: New_York-2023-A06059-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 6059--C 2023-2024 Regular Sessions IN ASSEMBLY March 31, 2023 ___________ Introduced by M. of A. SIMONE, BRONSON, COLTON, COOK, CRUZ, GLICK, GUNTHER, HEVESI, McDONOUGH, REYES, SAYEGH, SEAWRIGHT, SIMON, TAYLOR, THIELE, WOERNER, MAGNARELLI, JACOBSON, HUNTER, GONZALEZ-ROJAS, EPSTEIN, DAVILA, BURDICK, RAGA, BORES -- read once and referred to the Committee on Insurance -- recommitted to the Committee on Insurance in accordance with Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said commit- tee -- again reported from said committee with amendments, ordered reprinted as amended and recommitted to said committee -- again reported from said committee with amendments, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law and the insurance law, in relation to prohibiting health insurers from requiring prior authorization for pre-exposure prophylaxis used to prevent HIV infection The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 4406-c of the public health law is amended by 2 adding a new subdivision 14 to read as follows: 3 14. A health care plan which provides prescription drug coverage shall 4 not require a prior authorization determination for pre-exposure prophy- 5 laxis used to prevent HIV infection, provided that the health care plan 6 can confirm that the subscriber prescribed pre-exposure prophylaxis has 7 tested negative for HIV within the previous one hundred twenty days. 8 Nothing in this subdivision shall prohibit a health care plan from 9 requiring a subscriber undergo a step therapy protocol subject to arti- 10 cle forty-nine of this chapter before providing coverage of the 11 prescribed drug or denying a claim for such services if the services are 12 subsequently determined not to be medically necessary. 13 § 2. Section 3217-b of the insurance law is amended by adding a new 14 subsection (p) to read as follows: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD07908-06-4A. 6059--C 2 1 (p) An insurer which provides prescription drug coverage shall not 2 require a prior authorization determination for pre-exposure prophylaxis 3 used to prevent HIV infection, provided that the insurer can confirm 4 that the insured prescribed pre-exposure prophylaxis has tested negative 5 for HIV within the previous one hundred twenty days. Nothing in this 6 subsection shall prohibit an insurer from requiring an insured undergo a 7 step therapy protocol subject to article forty-nine of this chapter 8 before providing coverage of the prescribed drug or denying a claim for 9 such services if the services are subsequently determined not to be 10 medically necessary. 11 § 3. Section 4325 of the insurance law is amended by adding a new 12 subsection (p) to read as follows: 13 (p) A corporation organized under this article which provides 14 prescription drug coverage shall not require a prior authorization 15 determination for pre-exposure prophylaxis used to prevent HIV 16 infection, provided that the corporation can confirm that the insured 17 prescribed pre-exposure prophylaxis has tested negative for HIV within 18 the previous one hundred twenty days. Nothing in this subsection shall 19 prohibit a corporation organized under this article from requiring an 20 insured undergo a step therapy protocol subject to article forty-nine of 21 this chapter before providing coverage of the prescribed drug or denying 22 a claim for such services if the services are subsequently determined 23 not to be medically necessary. 24 § 4. This act shall take effect on the one hundred eightieth day after 25 it shall have become a law.