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A06059 Summary:

BILL NOA06059C
 
SAME ASNo Same As
 
SPONSORSimone
 
COSPNSRBronson, Colton, Cook, Cruz, Glick, Gunther, Hevesi, McDonough, Reyes, Sayegh, Seawright, Simon, Taylor, Thiele, Woerner, Magnarelli, Rosenthal D, Jacobson, Hunter, Gonzalez-Rojas, Epstein, Davila, Burdick, Raga, Bores
 
MLTSPNSR
 
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.
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A06059 Text:



 
                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.
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