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.
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.