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A06059 Summary:

BILL NOA06059A
 
SAME ASSAME AS S03227-A
 
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
 
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.
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A06059 Actions:

BILL NOA06059A
 
03/31/2023referred to insurance
01/03/2024referred to insurance
03/12/2024amend and recommit to insurance
03/12/2024print number 6059a
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A06059 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A6059A
 
SPONSOR: Simone
  TITLE OF BILL: 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   PURPOSE OR GENERAL IDEA OF BILL: To prohibit health insurers from requiring prior authorization for pre- exposure prophylaxis used to prevent HIV infection.   SUMMARY OF SPECIFIC PROVISIONS: Section 1 of the bill adds a new subdivision 11 to § 4406-c of the public health law stating that a health care plan which provides prescription drug coverage shall not require prior authorization for pre-exposure prophylaxis used to prevent HIV infection. Section 2 of the bill amends section 3217-b of the insurance law to prohibit prior authorization for per-exposure prophylaxis used to prevent HIV infection. Section 3 of the bill amends section 4325 of the insurance law to prohibit prior authorization for pre-exposure prophylaxis used to prevent HIV infection. Section 4 is the effective date.   JUSTIFICATION: The U.S. Preventive Services Task Force recommends that health care providers be encouraged to offer PrEP to patients at risk of HIV infection. This will significantly increase access to this important medication that prevents HIV infection. New Yorkers at risk for HIV have faced barriers in accessing PrEP. Complaints to the NYS Department of Financial Services about health insurance plans "use of stringent prior authorization requirements and improper denials of coverage" resulted in the agency sending a December 2017 circular letter to all health insurers reiterating that "issuers offering prescription drug coverage must cover PrEP," that "such cover- age should be subject only to reasonable utilization management meas- ures" and that "no insured may be discriminated against in the prescrib- ing or coverage of medically necessary treatments." Health care providers, adequately screening for well-known HIV risk factors with their patients, should be the only step needed to access PrEP. Passage of this legislation will result in fewer people contracting HIV.   PRIOR LEGISLATIVE HISTORY: 2021-2022: referred to Insurance Committee 2019-2020: referred to Insurance Committee   FISCAL IMPLICATIONS: None to the State.   EFFECTIVE DATE: 180 days after it shall have become a law.
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A06059 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         6059--A
 
                               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
          -- 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 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. 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 (p) to read as follows:
    10    (p) 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 (p) to read as follows:
    17    (p)   A  corporation  organized  under  this  article  which  provides
    18  prescription drug coverage  shall  not  require  a  prior  authorization
    19  determination   for   pre-exposure   prophylaxis  used  to  prevent  HIV
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD07908-03-4

        A. 6059--A                          2
 
     1  infection. Nothing in  this  subsection  shall  prohibit  a  corporation
     2  organized  under  this article from denying a claim for such services if
     3  the services are subsequently determined not medically necessary.
     4    § 4. This act shall take effect on the one hundred eightieth day after
     5  it shall have become a law.
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