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Assembly Bill A2799A

2019-2020 Legislative Session

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

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Archive: Last Bill Status - In Assembly Committee

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Bill Amendments

co-Sponsors

2019-A2799 - Details

See Senate Version of this Bill:
S1794
Current Committee:
Assembly Ways And Means
Law Section:
Social Services Law
Laws Affected:
Amd §364-j, rpld sub 25-a, Soc Serv L
Versions Introduced in Other Legislative Sessions:
2017-2018: A4007, S6541
2021-2022: S1588
2023-2024: S503

2019-A2799 - Summary

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

2019-A2799 - Bill Text download pdf 

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2799
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 25, 2019
                                ___________
 
 Introduced by M. of A. GOTTFRIED, RODRIGUEZ -- 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.
                                                            LBD03448-01-9

co-Sponsors

2019-A2799A (ACTIVE) - Details

See Senate Version of this Bill:
S1794
Current Committee:
Assembly Ways And Means
Law Section:
Social Services Law
Laws Affected:
Amd §364-j, rpld sub 25-a, Soc Serv L
Versions Introduced in Other Legislative Sessions:
2017-2018: A4007, S6541
2021-2022: S1588
2023-2024: S503

2019-A2799A (ACTIVE) - Summary

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

2019-A2799A (ACTIVE) - Bill Text download pdf 

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  2799--A
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 25, 2019
                                ___________
 
 Introduced by M. of A. GOTTFRIED, RODRIGUEZ -- read once and referred to
   the  Committee  on Health -- reported and referred to the Committee on
   Ways  and  Means  --  committee  discharged,  bill  amended,   ordered
   reprinted as amended and recommitted to said committee
 
 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 TITLE  (MANDATORY  GENERIC
 SUBSTITUTION),  AND  EVEN  IF  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-AP-
 PROVED LABELING OR SUPPORTED BY ONE OR MORE  OFFICIAL  COMPENDIA  REFER-
 ENCES,  INCLUDING,  BUT  NOT LIMITED TO, THE AMERICAN HOSPITAL FORMULARY
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

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