Bill Text: NY A07281 | 2019-2020 | 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.

Spectrum: Strong Partisan Bill (Democrat 32-2)

Status: (Introduced) 2020-03-02 - print number 7281a [A07281 Detail]

Download: New_York-2019-A07281-Amended.html



                STATE OF NEW YORK
        ________________________________________________________________________

                                         7281--A

                               2019-2020 Regular Sessions

                   IN ASSEMBLY

                                     April 18, 2019
                                       ___________

        Introduced  by  M. of A. GOTTFRIED, ARROYO, BRONSON, COLTON, COOK, CRUZ,
          DE LA ROSA, GLICK, GUNTHER, GRIFFIN, HEVESI, JAFFEE, McDONOUGH,  NIOU,
          ORTIZ,  REYES,  SAYEGH,  SCHMITT,  SEAWRIGHT,  SIMON, SIMOTAS, TAYLOR,
          THIELE,  WOERNER,  WRIGHT,  MAGNARELLI,  FERNANDEZ,  D. ROSENTHAL   --
          Multi-Sponsored  by -- M.  of A. GALEF, LENTOL, NOLAN -- 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 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 11 to read as follows:
     3    11. 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. Nothing in this  subdivision  shall
     6  prohibit  a  health  care plan from denying a claim for such services if
     7  the services are subsequently determined not medically necessary.
     8    § 2. Section 3217-b of the insurance law is amended by  adding  a  new
     9  subsection (m) to read as follows:
    10    (m)  An  insurer  which  provides prescription drug coverage shall not
    11  require a prior authorization determination for pre-exposure prophylaxis
    12  used to prevent HIV infection. Nothing in this subsection shall prohibit
    13  an insurer from denying a claim for such services if  the  services  are
    14  subsequently determined not medically necessary.
    15    §  3.  Section  4325  of  the insurance law is amended by adding a new
    16  subsection (n) to read as follows:

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD08766-04-0

        A. 7281--A                          2

     1    (n)  A  corporation  organized  under  this  article  which   provides
     2  prescription  drug  coverage  shall  not  require  a prior authorization
     3  determination  for  pre-exposure  prophylaxis  used   to   prevent   HIV
     4  infection.  Nothing  in  this  subsection  shall  prohibit a corporation
     5  organized  under  this article from denying a claim for such services if
     6  the services are subsequently determined not medically necessary.
     7    § 4. This act shall take effect on the one hundred eightieth day after
     8  it shall have become a law.
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