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Assembly Bill A4007

2017-2018 Legislative Session

Relates to coverage for certain prescription drugs in Medicaid managed care programs; repealer

download bill text pdf

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Archive: Last Bill Status - In Senate Committee Rules Committee

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2017-A4007 (ACTIVE) - Details

See Senate Version of this Bill:
S6541
Current Committee:
Senate Rules
Law Section:
Social Services Law
Laws Affected:
Amd §364-j, rpld sub 25-a, Soc Serv L
Versions Introduced in Other Legislative Sessions:
2019-2020: A2799, S1794
2021-2022: S1588
2023-2024: S503

2017-A4007 (ACTIVE) - Summary

Provides for coverage for certain medically necessary prescription drugs in Medicaid managed care programs.

2017-A4007 (ACTIVE) - Bill Text download pdf 

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4007
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 30, 2017
                                ___________
 
 Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
   Committee on Health
 
 AN ACT to amend the social services law, in  relation  to  coverage  for
   certain  prescription  drugs; and to repeal certain provisions of such
   law relating thereto
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 25 of section 364-j of the social services law,
 as  added  by section 55 of part D of chapter 56 of the laws of 2012, is
 amended to read as follows:
   25. [Effective January first, two thousand thirteen,  notwithstanding]
 NOTWITHSTANDING  any  provision  of  law  to  the contrary, managed care
 providers shall cover medically  necessary  prescription  drugs  in  the
 ANTI-DEPRESSANT,   ANTI-RETROVIRAL,  ANTIREJECTION,  SEIZURE,  EPILEPSY,
 ENDOCRINE, HEMATOLOGIC, IMMUNOLOGIC AND atypical antipsychotic therapeu-
 tic [class] CLASSES, including non-formulary drugs, upon [demonstration]
 DETERMINATION by THE PRESCRIBER UNDER THIS SUBDIVISION. IF the  prescri-
 ber,  after  consulting  with the managed care provider, DETERMINES that
 such drugs, in the prescriber's reasonable  professional  judgment,  are
 medically  necessary and warranted, THE PRESCRIBER'S DETERMINATION SHALL
 BE FINAL. HOWEVER, THE PRESCRIBER'S DETERMINATION SHALL  NOT  BE  FINAL:
 (A)  WHERE  THE  DRUG APPROVED BY THE MANAGED CARE PROVIDER IS A GENERIC
 DRUG SUBJECT TO SUBPARAGRAPH (I) OF PARAGRAPH (A-1) OF SUBDIVISION  FOUR
 OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS ARTICLE (MANDATORY GENERIC
 SUBSTITUTION),  AND  THE  PRESCRIBER HAS INDICATED THAT THE PRESCRIPTION
 SHALL BE DISPENSED AS WRITTEN; OR (B) IF IT IS FOR THE  USE  OF  A  DRUG
 THAT IS NOT CONSISTENT WITH FOOD AND DRUG ADMINISTRATION-APPROVED LABEL-
 ING  OR  SUPPORTED BY ONE OR MORE OFFICIAL COMPENDIA REFERENCES, INCLUD-
 ING, BUT NOT LIMITED TO, THE AMERICAN HOSPITAL FORMULARY SERVICE (AHFS),
 THE DRUGDEX DRUG INFORMATION SYSTEM AND THE UNITED STATES PHARMACOPEIA.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07092-02-7

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