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A06983 Summary:

BILL NO    A06983A

SAME AS    SAME AS S04721-A

SPONSOR    McDonald

COSPNSR    

MLTSPNSR   

Amd S4903, Pub Health L; amd S4903, Ins L

Directs the commissioner of health and superintendent of financial services to
establish a standard prior authorization request for a utilization review of
prescription drug coverage.
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A06983 Text:

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________

                                        6983--A
                                                               Cal. No. 333

                              2015-2016 Regular Sessions

                                 I N  A S S E M B L Y

                                    April 16, 2015
                                      ___________

       Introduced by M. of A. McDONALD -- read once and referred to the Commit-
         tee on Health -- reported from committee, advanced to a third reading,
         amended  and  ordered  reprinted,  retaining its place on the order of
         third reading

       AN ACT to amend the public health law and the insurance law, in relation
         to standards for prior authorization requests for a utilization review
         of prescription drug coverage

         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:

    1    Section  1. Section 4903 of the public health law is amended by adding
    2  a new subdivision 8 to read as follows:
    3    8. THE COMMISSIONER, IN CONJUNCTION WITH THE SUPERINTENDENT OF  FINAN-
    4  CIAL  SERVICES, SHALL DEVELOP STANDARDS FOR PRIOR AUTHORIZATION REQUESTS
    5  TO BE UTILIZED BY ALL HEALTH CARE PLANS FOR THE PURPOSES OF SUBMITTING A
    6  REQUEST  FOR  A  UTILIZATION  REVIEW  DETERMINATION  FOR   COVERAGE   OF
    7  PRESCRIPTION  DRUG  BENEFITS UNDER THIS ARTICLE.  THE DEPARTMENT AND THE
    8  DEPARTMENT OF FINANCIAL SERVICES, IN DEVELOPMENT OF THE STANDARDS, SHALL
    9  TAKE INTO CONSIDERATION EXISTING ELECTRONIC PRIOR  AUTHORIZATION  STAND-
   10  ARDS  INCLUDING  NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS (NCPDP)
   11  ELECTRONIC PRIOR AUTHORIZATION STANDARD TRANSACTIONS.
   12    S 2. Section 4903 of the insurance law is  amended  by  adding  a  new
   13  subsection (h) to read as follows:
   14    (H)  THE  SUPERINTENDENT,  IN  CONJUNCTION  WITH  THE  COMMISSIONER OF
   15  HEALTH, SHALL DEVELOP STANDARDS FOR PRIOR AUTHORIZATION REQUESTS  TO  BE
   16  UTILIZED  BY  ALL  HEALTH  CARE  PLANS  FOR THE PURPOSES OF SUBMITTING A
   17  REQUEST  FOR  A  UTILIZATION  REVIEW  DETERMINATION  FOR   COVERAGE   OF
   18  PRESCRIPTION  DRUG  BENEFITS UNDER THIS ARTICLE.  THE DEPARTMENT AND THE
   19  DEPARTMENT OF HEALTH, IN DEVELOPMENT OF THE STANDARDS, SHALL  TAKE  INTO
   20  CONSIDERATION  EXISTING ELECTRONIC PRIOR AUTHORIZATION STANDARDS INCLUD-
   21  ING NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS  (NCPDP)  ELECTRONIC
   22  PRIOR AUTHORIZATION STANDARD TRANSACTIONS.

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD04038-02-5
       A. 6983--A                          2

    1    S 3. This act shall take effect immediately.
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