Amd §4406-c, Pub Health L; amd §§3217-b & 4325, Ins L
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.
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.
LBD07908-06-4
A. 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.
