STATE OF NEW YORK
________________________________________________________________________
7281--A
2019-2020 Regular Sessions
IN ASSEMBLY
April 18, 2019
___________
Introduced by M. of A. GOTTFRIED, ARROYO, BRONSON, COLTON, COOK, CRUZ,
DE LA ROSA, GLICK, GUNTHER, GRIFFIN, HEVESI, JAFFEE, McDONOUGH, NIOU,
ORTIZ, REYES, SAYEGH, SCHMITT, SEAWRIGHT, SIMON, SIMOTAS, TAYLOR,
THIELE, WOERNER, WRIGHT, MAGNARELLI, FERNANDEZ, D. ROSENTHAL --
Multi-Sponsored by -- M. of A. GALEF, LENTOL, NOLAN -- 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 11 to read as follows:
3 11. 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 (m) to read as follows:
10 (m) 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 (n) to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD08766-04-0
A. 7281--A 2
1 (n) A corporation organized under this article which provides
2 prescription drug coverage shall not require a prior authorization
3 determination for pre-exposure prophylaxis used to prevent HIV
4 infection. Nothing in this subsection shall prohibit a corporation
5 organized under this article from denying a claim for such services if
6 the services are subsequently determined not medically necessary.
7 § 4. This act shall take effect on the one hundred eightieth day after
8 it shall have become a law.
