Bill Text: NY A07208 | 2015-2016 | General Assembly | Introduced

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Bill Title: Relates to coverage of certain prescription drugs including antipsychotic, anti-depressant, anti-retroviral, anti-rejection, seizure and immunologic class drugs by Medicaid managed care providers; makes prescriber's determination final.

Spectrum: Strong Partisan Bill (Democrat 49-5)

Status: (Vetoed) 2015-08-14 - tabled [A07208 Detail]

Download: New_York-2015-A07208-Introduced.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         7208
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                    April 28, 2015
                                      ___________
       Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
         Committee on Health
       AN ACT to amend the social  services  law,  in  relation  to  prescriber
         determination  prevailing  in  medicaid  managed  care  and  to repeal
         certain provisions of such law relating thereto
         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section 1. Subdivision 25 of section 364-j of the social services law,
    2  as  added  by section 55 of part D of chapter 56 of the laws of 2012, is
    3  amended to read as follows:
    4    25. [Effective January first, two thousand thirteen,  notwithstanding]
    5  NOTWITHSTANDING  any  provision  of  law  to  the contrary, managed care
    6  providers shall cover medically  necessary  prescription  drugs  in  the
    7  ANTI-DEPRESSANT,  ANTI-RETROVIRAL,  ANTI-REJECTION,  SEIZURE,  EPILEPSY,
    8  ENDOCRINE, HEMATOLOGIC, IMMUNOLOGIC AND atypical antipsychotic therapeu-
    9  tic [class] CLASSES, including non-formulary drugs[, upon  demonstration
   10  by]. IF the prescriber, after consulting with the managed care provider,
   11  DETERMINES  that such drugs, in the prescriber's reasonable professional
   12  judgment, are medically necessary and warranted, THE PRESCRIBER'S DETER-
   13  MINATION SHALL BE FINAL.
   14    S 2. Subdivision 25-a of section 364-j of the social services  law  is
   15  REPEALED.
   16    S  3.  This  act  shall take effect on the sixtieth day after it shall
   17  have become a law; provided that effective immediately, the commissioner
   18  of health may make regulations  and  take  other  actions  necessary  to
   19  implement  this act on that date, and provided, further, that the amend-
   20  ments to section 364-j of the social services law made by this act shall
   21  not affect the repeal of such section and shall be deemed repealed ther-
   22  ewith.
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD09267-02-5