Prohibits Medicaid from requiring prior authorization for certain HIV medications, the official text

S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    26
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 8, 2025
                                ___________
 
 Introduced  by  M.  of  A.  ROSENTHAL  --  read once and referred to the
   Committee on Health
 
 AN ACT to amend the social services law and the public  health  law,  in
   relation  to  prohibiting  Medicaid from requiring prior authorization
   for HIV medication

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph  (g-1) of subdivision 2 of section 365-a of the
 social services law, as amended by section 9 of part D of chapter 57  of
 the laws of 2017, is amended to read as follows:
   (g-1)  drugs provided on an in-patient basis, those drugs contained on
 the list established by regulation of the commissioner of health  pursu-
 ant  to  subdivision four of this section, and those drugs which may not
 be dispensed without a prescription as required by  section  sixty-eight
 hundred  ten  of  the education law and which the commissioner of health
 shall determine to be reimbursable based upon such factors as the avail-
 ability of such drugs or alternatives at low  cost  if  purchased  by  a
 medicaid  recipient,  or the essential nature of such drugs as described
 by such commissioner in regulations, provided, however, that such drugs,
 exclusive of long-term maintenance drugs, shall be dispensed in  quanti-
 ties no greater than a thirty day supply or one hundred doses, whichever
 is  greater; provided further that the commissioner of health is author-
 ized to require prior authorization for any  refill  of  a  prescription
 when  more  than  a  ten  day  supply of the previously dispensed amount
 should remain were the product used as normally  indicated,  or  in  the
 case  of  a  controlled  substance,  as  defined in section thirty-three
 hundred two of the public health law, when more than a seven day  supply
 of  the  previously dispensed amount should remain were the product used
 as normally indicated; provided further that the commissioner of  health
 is  authorized to require prior authorization of prescriptions of opioid
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD00020-01-5
 A. 26                               2
 
 analgesics in excess of four prescriptions in  a  thirty-day  period  in
 accordance  with  section two hundred seventy-three of the public health
 law; PROVIDED FURTHER THAT THE COMMISSIONER OF HEALTH SHALL NOT  REQUIRE
 PRIOR  AUTHORIZATION OF ANTIRETROVIRAL PRESCRIPTION DRUGS FOR THE TREAT-
 MENT OR PREVENTION OF THE HUMAN IMMUNODEFICIENCY VIRUS (HIV) OR ACQUIRED
 IMMUNODEFICIENCY SYNDROME (AIDS); medical assistance shall  not  include
 any  drug provided on other than an in-patient basis for which a recipi-
 ent is charged or a claim is made in the case of a prescription drug, in
 excess of the maximum reimbursable amounts to be established by  depart-
 ment  regulations in accordance with standards established by the secre-
 tary of the United States department of health and human  services,  or,
 in  the  case  of  a drug not requiring a prescription, in excess of the
 maximum reimbursable amount established by the  commissioner  of  health
 pursuant to paragraph (a) of subdivision four of this section;
   §  2.  Section 364-j of the social services law is amended by adding a
 new subdivision 26-d to read as follows:
   26-D. MANAGED CARE PROVIDERS SHALL NOT REQUIRE PRIOR AUTHORIZATION FOR
 ANY ANTIRETROVIRAL PRESCRIPTION DRUGS FOR THE TREATMENT OR PREVENTION OF
 THE HUMAN IMMUNODEFICIENCY  VIRUS  (HIV)  OR  ACQUIRED  IMMUNODEFICIENCY
 SYNDROME (AIDS).
   §  3.  Section 273 of the public health law is amended by adding a new
 subdivision 11 to read as follows:
   11. PRIOR AUTHORIZATION  SHALL  NOT  BE  REQUIRED  FOR  ANTIRETROVIRAL
 PRESCRIPTION  DRUGS PRESCRIBED TO A PERSON IN A STATE PUBLIC HEALTH PLAN
 FOR THE TREATMENT OR PREVENTION  OF  THE  HUMAN  IMMUNODEFICIENCY  VIRUS
 (HIV) OR ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS).
   § 4. This act shall take effect on the one hundred eightieth day after
 it  shall  have  become a law; provided, however, that the amendments to
 section 364-j of the social services law made by section two of this act
 shall not affect the repeal of such section and shall be deemed repealed
 therewith.