S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2843
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 25, 2019
                                ___________
 
 Introduced  by  M.  of  A.  RODRIGUEZ, ARROYO, AUBRY, ABBATE, BENEDETTO,
   JAFFEE, ABINANTI, RAIA,  MAGNARELLI,  PERRY,  PAULIN,  PEOPLES-STOKES,
   GOTTFRIED  --  Multi-Sponsored  by  -- M. of A. GIGLIO, GLICK, LAVINE,
   LENTOL, LIFTON, LUPARDO, SIMON, THIELE -- read once  and  referred  to
   the Committee on Health

 AN  ACT  to  amend the social services law and the public health law, in
   relation to prescription drugs in Medicaid managed care programs;  and
   to  repeal  certain provisions of the social services law, relating to
   payments for prescription drugs
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1. The social services law is amended by adding a new section
 365-i to read as follows:
   § 365-I. PRESCRIPTION DRUGS IN MEDICAID MANAGED  CARE  PROGRAMS.    1.
 DEFINITIONS.  AS  USED  IN  THIS  SECTION,  UNLESS  THE  CONTEXT CLEARLY
 REQUIRES OTHERWISE:
   (A) "ARTICLE" MEANS TITLE ELEVEN OF ARTICLE FIVE OF THIS CHAPTER  WITH
 RESPECT  TO  THE  MEDICAL ASSISTANCE PROGRAM, AND TITLE ONE-A OF ARTICLE
 TWENTY-FIVE OF THE PUBLIC HEALTH LAW WITH RESPECT TO  THE  CHILD  HEALTH
 INSURANCE PLAN.
   (B)  "CLINICAL  DRUG  REVIEW  PROGRAM"  MEANS THE CLINICAL DRUG REVIEW
 PROGRAM UNDER SECTION TWO HUNDRED SEVENTY-FOUR OF THE PUBLIC HEALTH LAW.
   (C) "EMERGENCY CONDITION" MEANS A MEDICAL OR BEHAVIORAL  CONDITION  AS
 DETERMINED  BY  THE  PRESCRIBER  OR  PHARMACIST,  THE  ONSET OF WHICH IS
 SUDDEN, THAT  MANIFESTS  ITSELF  BY  SYMPTOMS  OF  SUFFICIENT  SEVERITY,
 INCLUDING  SEVERE  PAIN,  AND  FOR  WHICH  DELAY  IN BEGINNING TREATMENT
 PRESCRIBED BY THE PATIENT'S HEALTH CARE PRACTITIONER WOULD RESULT IN:
   (I) PLACING THE HEALTH OR SAFETY OF THE  PERSON  AFFLICTED  WITH  SUCH
 CONDITION OR OTHER PERSON OR PERSONS IN SERIOUS JEOPARDY;
   (II) SERIOUS IMPAIRMENT TO SUCH PERSON'S BODILY FUNCTIONS;
   (III) SERIOUS DYSFUNCTION OF ANY BODILY ORGAN OR PART OF SUCH PERSON;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD06484-02-9

 A. 2843                             2
 
   (IV) SERIOUS DISFIGUREMENT OF SUCH PERSON; OR
   (V) SEVERE DISCOMFORT.
   (D)  "MANAGED  CARE  PROVIDER"  MEANS  A  MANAGED  CARE PROVIDER UNDER
 SECTION THREE HUNDRED SIXTY-FOUR-J OF THIS TITLE, A  MANAGED  LONG  TERM
 CARE  PLAN  OR  OTHER  CARE  COORDINATION MODEL UNDER SECTION FORTY-FOUR
 HUNDRED THREE-F OF THE PUBLIC HEALTH LAW, AN APPROVED ORGANIZATION UNDER
 TITLE ONE-A OF ARTICLE TWENTY-FIVE  OF  THE  PUBLIC  HEALTH  LAW  (CHILD
 HEALTH  INSURANCE  PLAN),  OR ANY OTHER ENTITY THAT PROVIDES OR ARRANGES
 FOR THE PROVISION OF MEDICAL ASSISTANCE SERVICES AND SUPPLIES TO PARTIC-
 IPANTS DIRECTLY OR INDIRECTLY (INCLUDING BY  REFERRAL),  INCLUDING  CASE
 MANAGEMENT, INCLUDING THE MANAGED CARE PROVIDER'S AUTHORIZED AGENTS.
   (E) "NON-PREFERRED DRUG" MEANS A PRESCRIPTION DRUG THAT REQUIRES PRIOR
 AUTHORIZATION UNDER THE PARTICIPANT'S MANAGED CARE PROVIDER.
   (F)  "PARTICIPANT"  MEANS A MEDICAL ASSISTANCE RECIPIENT WHO RECEIVES,
 IS REQUIRED TO RECEIVE OR ELECTS TO RECEIVE HIS OR HER  MEDICAL  ASSIST-
 ANCE SERVICES FROM A MANAGED CARE PROVIDER.
   (G)  "PREFERRED DRUG" MEANS A PRESCRIPTION DRUG THAT IS NOT A NON-PRE-
 FERRED DRUG UNDER THE PATIENT'S MANAGED CARE PROVIDER.  "PREFERRED  DRUG
 LIST" MEANS A LIST OF A MANAGED CARE PROVIDER'S PREFERRED DRUGS.
   (H)  "PREFERRED  DRUG PROGRAM" MEANS THE PREFERRED DRUG PROGRAM ESTAB-
 LISHED UNDER SECTION TWO HUNDRED SEVENTY-TWO OF THE PUBLIC HEALTH LAW.
   (I) "PRESCRIBER"  MEANS  A  HEALTH  CARE  PROFESSIONAL  AUTHORIZED  TO
 PRESCRIBE  PRESCRIPTION  DRUGS  FOR  A  PARTICIPANT  OF THE MANAGED CARE
 PROVIDER, ACTING WITHIN HIS OR HER LAWFUL SCOPE OF PRACTICE.
   (J) "PRESCRIPTION DRUG" OR "DRUG" MEANS A DRUG DEFINED IN  SUBDIVISION
 SEVEN OF SECTION SIXTY-EIGHT HUNDRED TWO OF THE EDUCATION LAW, FOR WHICH
 A  PRESCRIPTION  IS  REQUIRED  UNDER THE FEDERAL FOOD, DRUG AND COSMETIC
 ACT. ANY DRUG THAT DOES NOT REQUIRE A PRESCRIPTION UNDER SUCH  ACT,  BUT
 WHICH  WOULD  OTHERWISE BE ELIGIBLE FOR REIMBURSEMENT UNDER THIS ARTICLE
 WHEN ORDERED BY A PRESCRIBER AND THE  PRESCRIPTION  IS  SUBJECT  TO  THE
 APPLICABLE  PROVISIONS  OF THIS ARTICLE AND PARAGRAPH (A) OF SUBDIVISION
 FOUR OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE.
   (K) "PRIOR AUTHORIZATION" MEANS A PROCESS REQUIRING THE PRESCRIBER  OR
 THE  DISPENSER  TO  VERIFY  WITH THE PARTICIPANT'S MANAGED CARE PROVIDER
 THAT THE DRUG IS APPROPRIATE FOR THE NEEDS OF THE SPECIFIC PATIENT.
   (L) "QUALIFIED PRESCRIPTION DRUG SYSTEM" OR "SYSTEM" MEANS  A  PROCESS
 UNDER  THIS  SECTION,  APPROVED  BY  THE  COMMISSIONER,  THROUGH WHICH A
 MANAGED CARE PROVIDER APPROVES PAYMENT FOR A NON-PREFERRED  DRUG  FOR  A
 PARTICIPANT BASED ON PRIOR AUTHORIZATION.
   2.  PAYMENT  FOR  PRESCRIPTION DRUGS UNDER CAPITATION. (A) PAYMENT FOR
 PRESCRIPTION DRUGS SHALL BE INCLUDED  IN  THE  CAPITATION  PAYMENTS  FOR
 SERVICES OR SUPPLIES PROVIDED TO A MANAGED CARE PROVIDER'S PARTICIPANTS,
 PROVIDED  THAT  THE  MANAGED  CARE  PROVIDER PAYS FOR PRESCRIPTION DRUGS
 UNDER A QUALIFIED PRESCRIPTION  DRUG  SYSTEM.  EVERY  PRESCRIPTION  DRUG
 ELIGIBLE  FOR REIMBURSEMENT UNDER THIS ARTICLE PRESCRIBED IN RELATION TO
 A SERVICE PROVIDED BY THE  MANAGED  CARE  PROVIDER  SHALL  BE  EITHER  A
 PREFERRED  OR  NON-PREFERRED  DRUG UNDER THE QUALIFIED PRESCRIPTION DRUG
 SYSTEM.  THE COMMISSIONER SHALL APPROVE A MANAGED CARE PROVIDER'S QUALI-
 FIED PRESCRIPTION DRUG SYSTEM IF IT CONFORMS TO THE PROVISIONS  OF  THIS
 SECTION.
   (B)  IF  THE MANAGED CARE PROVIDER DOES NOT PAY FOR PRESCRIPTION DRUGS
 UNDER  A  QUALIFIED  PRESCRIPTION  DRUG   SYSTEM,   THEN   PAYMENT   FOR
 PRESCRIPTION DRUGS FOR THE MANAGED CARE PROVIDER'S PATIENTS SHALL NOT BE
 INCLUDED  IN  SUCH  CAPITATION  PAYMENTS AND PRESCRIPTION DRUGS SHALL BE
 PROVIDED  FOR  THE  MANAGED  CARE  PROVIDER'S  PARTICIPANTS  UNDER   THE
 PREFERRED DRUG PROGRAM.

 A. 2843                             3

   3.  QUALIFIED  PRESCRIPTION  DRUG  SYSTEM;  CRITERIA.  (A) A QUALIFIED
 PRESCRIPTION DRUG SYSTEM SHALL PROMOTE  ACCESS  TO  THE  MOST  EFFECTIVE
 PRESCRIPTION  DRUGS  WHILE REDUCING THE COST OF PRESCRIPTION DRUGS UNDER
 THIS ARTICLE. THIS SUBDIVISION AND  SUBDIVISION  FOUR  OF  THIS  SECTION
 APPLY TO QUALIFIED PRESCRIPTION DRUG SYSTEMS.
   (B)  WHEN  A  PRESCRIBER PRESCRIBES A NON-PREFERRED DRUG FOR A PARTIC-
 IPANT,  REIMBURSEMENT  MAY  BE  DENIED  UNLESS  PRIOR  AUTHORIZATION  IS
 OBTAINED,  UNLESS NO PRIOR AUTHORIZATION IS REQUIRED UNDER THIS SECTION.
 WHEN A PRESCRIBER PRESCRIBES A PREFERRED  DRUG  FOR  A  PARTICIPANT,  NO
 PRIOR  AUTHORIZATION  SHALL  BE REQUIRED FOR REIMBURSEMENT, UNLESS PRIOR
 AUTHORIZATION IS REQUIRED UNDER THE CLINICAL DRUG REVIEW PROGRAM.
   (C) THE COMMISSIONER SHALL ESTABLISH PERFORMANCE STANDARDS FOR SYSTEMS
 THAT, AT A MINIMUM, ENSURE THAT  SYSTEMS  PROVIDE  SUFFICIENT  TECHNICAL
 SUPPORT AND TIMELY RESPONSES TO CONSUMERS, PRESCRIBERS AND PHARMACISTS.
   (D)  THE  COMMISSIONER SHALL ADOPT CRITERIA FOR QUALIFIED PRESCRIPTION
 DRUG SYSTEMS AFTER CONSIDERING  RECOMMENDATIONS  AND  COMMENTS  RECEIVED
 FROM  PRESCRIBERS,  PHARMACISTS, PARTICIPANTS, AND ORGANIZATIONS REPRES-
 ENTING THEM.
   (E) THE MANAGED CARE PROVIDER SHALL DEVELOP ITS  PREFERRED  DRUG  LIST
 BASED  INITIALLY ON AN EVALUATION OF THE CLINICAL EFFECTIVENESS, SAFETY,
 AND PATIENT OUTCOMES, FOLLOWED BY CONSIDERATION OF  THE  COST-EFFECTIVE-
 NESS  OF THE DRUGS. IN EACH THERAPEUTIC CLASS, THE MANAGED CARE PROVIDER
 SHALL DETERMINE WHETHER THERE IS ONE DRUG  THAT  IS  SIGNIFICANTLY  MORE
 CLINICALLY  EFFECTIVE  AND  SAFE, AND THAT DRUG SHALL BE INCLUDED ON THE
 PREFERRED DRUG LIST WITHOUT CONSIDERATION OF COST. IF, AMONG TWO OR MORE
 DRUGS IN A THERAPEUTIC CLASS, THE DIFFERENCE IN  CLINICAL  EFFECTIVENESS
 AND  SAFETY  IS  NOT CLINICALLY SIGNIFICANT, THEN COST-EFFECTIVENESS MAY
 ALSO BE CONSIDERED IN DETERMINING WHICH DRUG OR DRUGS SHALL BE  INCLUDED
 ON THE PREFERRED DRUG LIST.
   4. PRIOR AUTHORIZATION. (A) A QUALIFIED PRESCRIPTION DRUG SYSTEM SHALL
 MAKE AVAILABLE A TWENTY-FOUR HOUR PER DAY, SEVEN DAYS PER WEEK TELEPHONE
 CALL  CENTER  THAT  INCLUDES  A  TOLLFREE  TELEPHONE  LINE AND DEDICATED
 FACSIMILE LINE TO RESPOND TO REQUESTS FOR PRIOR AUTHORIZATION. THE  CALL
 CENTER  SHALL  INCLUDE  QUALIFIED HEALTH CARE PROFESSIONALS WHO SHALL BE
 AVAILABLE TO CONSULT WITH PRESCRIBERS CONCERNING PRESCRIPTION DRUGS THAT
 ARE NON-PREFERRED DRUGS. A PRESCRIBER SEEKING PRIOR AUTHORIZATION  SHALL
 CONSULT  WITH  THE  PROGRAM  CALL  LINE TO REASONABLY PRESENT HIS OR HER
 JUSTIFICATION FOR THE PRESCRIPTION  AND  GIVE  THE  PROGRAM'S  QUALIFIED
 HEALTH CARE PROFESSIONAL A REASONABLE OPPORTUNITY TO RESPOND.
   (B)  WHEN  A PATIENT'S HEALTH CARE PROVIDER PRESCRIBES A NON-PREFERRED
 DRUG, THE PRESCRIBER SHALL CONSULT WITH THE SYSTEM TO  CONFIRM  THAT  IN
 HIS  OR  HER  REASONABLE  PROFESSIONAL  JUDGMENT, THE PATIENT'S CLINICAL
 CONDITION IS CONSISTENT WITH THE CRITERIA FOR APPROVAL OF  THE  NON-PRE-
 FERRED DRUG. SUCH CRITERIA SHALL INCLUDE:
   (I) THE PREFERRED DRUG HAS BEEN TRIED BY THE PATIENT AND HAS FAILED TO
 PRODUCE THE DESIRED HEALTH OUTCOMES;
   (II)  THE  PATIENT  HAS  TRIED  THE PREFERRED DRUG AND HAS EXPERIENCED
 UNACCEPTABLE SIDE EFFECTS;
   (III) THE PATIENT HAS BEEN STABILIZED  ON  A  NON-PREFERRED  DRUG  AND
 TRANSITION TO THE PREFERRED DRUG WOULD BE MEDICALLY CONTRAINDICATED; OR
   (IV)  OTHER CLINICAL INDICATIONS IDENTIFIED BY THE COMMISSIONER OR THE
 MANAGED CARE PROVIDER FOR THE PATIENT'S USE OF THE  NON-PREFERRED  DRUG,
 WHICH  SHALL INCLUDE CONSIDERATION OF THE MEDICAL NEEDS OF SPECIAL POPU-
 LATIONS, INCLUDING CHILDREN,  ELDERLY,  CHRONICALLY  ILL,  PERSONS  WITH
 MENTAL  HEALTH CONDITIONS, AND PERSONS AFFECTED BY HIV/AIDS OR HEPATITIS
 C.

 A. 2843                             4
 
   (C) IN THE EVENT THAT THE PATIENT DOES NOT MEET THE CRITERIA IN  PARA-
 GRAPH  (B)  OF  THIS  SUBDIVISION, THE PRESCRIBER MAY PROVIDE ADDITIONAL
 INFORMATION TO THE MANAGED CARE PROVIDER TO JUSTIFY THE USE  OF  A  NON-
 PREFERRED  DRUG. THE SYSTEM SHALL PROVIDE A REASONABLE OPPORTUNITY FOR A
 PRESCRIBER  TO  REASONABLY  PRESENT  HIS  OR  HER JUSTIFICATION OF PRIOR
 AUTHORIZATION. IF, AFTER CONSULTATION WITH THE  MANAGED  CARE  PROVIDER,
 THE  PRESCRIBER,  IN HIS OR HER REASONABLE PROFESSIONAL JUDGMENT, DETER-
 MINES  THAT  THE  USE  OF  A  NON-PREFERRED  DRUG  IS   WARRANTED,   THE
 PRESCRIBER'S DETERMINATION SHALL BE FINAL.
   (D)  IF A PRESCRIBER MEETS THE REQUIREMENTS OF PARAGRAPH (B) OR (C) OF
 THIS SUBDIVISION, THE PRESCRIBER SHALL BE  GRANTED  PRIOR  AUTHORIZATION
 UNDER THIS SECTION.
   (E)  IN  THE INSTANCE WHERE A PRIOR AUTHORIZATION DETERMINATION IS NOT
 COMPLETED WITHIN TWENTY-FOUR HOURS OF THE ORIGINAL  REQUEST,  SOLELY  AS
 THE  RESULT  OF A FAILURE OF THE SYSTEM (WHETHER BY ACTION OR INACTION),
 PRIOR AUTHORIZATION SHALL BE IMMEDIATELY AND AUTOMATICALLY GRANTED  WITH
 NO FURTHER ACTION BY THE PRESCRIBER AND THE PRESCRIBER SHALL BE NOTIFIED
 OF  THIS  DETERMINATION.  IN  THE  INSTANCE  WHERE A PRIOR AUTHORIZATION
 DETERMINATION IS NOT COMPLETED WITHIN TWENTY-FOUR HOURS OF THE  ORIGINAL
 REQUEST  FOR  ANY OTHER REASON, A SEVENTY-TWO HOUR SUPPLY OF THE MEDICA-
 TION SHALL BE APPROVED BY THE SYSTEM AND THE PRESCRIBER SHALL  BE  NOTI-
 FIED OF THIS DETERMINATION.
   (F)  WHEN,  IN  THE  JUDGMENT  OF THE PRESCRIBER OR THE PHARMACIST, AN
 EMERGENCY CONDITION EXISTS, AND THE PRESCRIBER  OR  PHARMACIST  NOTIFIES
 THE  MANAGED  CARE PROVIDER THAT AN EMERGENCY CONDITION EXISTS, A SEVEN-
 TY-TWO HOUR EMERGENCY SUPPLY OF THE DRUG PRESCRIBED SHALL BE IMMEDIATELY
 AUTHORIZED BY THE MANAGED CARE PROVIDER.
   (G) IN THE EVENT THAT A PATIENT PRESENTS A PRESCRIPTION TO  A  PHARMA-
 CIST  FOR A PRESCRIPTION DRUG THAT IS A NON-PREFERRED DRUG AND FOR WHICH
 THE PRESCRIBER HAS NOT OBTAINED A PRIOR  AUTHORIZATION,  THE  PHARMACIST
 SHALL, WITHIN A PROMPT PERIOD BASED ON PROFESSIONAL JUDGMENT, NOTIFY THE
 PRESCRIBER.  THE  PRESCRIBER  SHALL,  WITHIN  A  PROMPT  PERIOD BASED ON
 PROFESSIONAL JUDGMENT, EITHER SEEK PRIOR AUTHORIZATION OR SHALL  CONTACT
 THE  PHARMACIST  AND  AMEND  OR  CANCEL THE PRESCRIPTION. THE PHARMACIST
 SHALL, WITHIN A PROMPT PERIOD BASED ON PROFESSIONAL JUDGMENT, NOTIFY THE
 PATIENT WHEN PRIOR AUTHORIZATION HAS BEEN OBTAINED OR DENIED OR WHEN THE
 PRESCRIPTION HAS BEEN AMENDED OR CANCELLED.
   (H) ONCE PRIOR AUTHORIZATION OF A PRESCRIPTION FOR A DRUG THAT IS  NOT
 ON THE PREFERRED DRUG LIST IS OBTAINED, PRIOR AUTHORIZATION SHALL NOT BE
 REQUIRED FOR ANY REFILL OF THE PRESCRIPTION.
   (I)  NO PRIOR AUTHORIZATION UNDER A QUALIFIED PRESCRIPTION DRUG SYSTEM
 SHALL BE REQUIRED FOR: (I) ATYPICAL ANTI-PSYCHOTICS;  (II)  ANTI-DEPRES-
 SANTS; (III) ANTI-RETROVIRALS USED IN THE TREATMENT OF HIV/AIDS OR HEPA-
 TITIS  C;  (IV)  ANTI-REJECTION DRUGS USED IN THE TREATMENT OF ORGAN AND
 TISSUE TRANSPLANTS; AND (V) ANY OTHER THERAPEUTIC CLASS FOR  THE  TREAT-
 MENT OF MENTAL ILLNESS, HIV/AIDS OR HEPATITIS C, APPROVED BY THE COMMIS-
 SIONER.
   5. CLINICAL DRUG REVIEW PROGRAM. IN THE CASE OF A DRUG FOR WHICH PRIOR
 AUTHORIZATION  IS REQUIRED UNDER THE CLINICAL DRUG REVIEW PROGRAM, PRIOR
 AUTHORIZATION SHALL BE OBTAINED UNDER THE CLINICAL DRUG  REVIEW  PROGRAM
 AND NOT UNDER THIS SECTION.
   6.  PRESCRIBER  CONDUCT.  THE MANAGED CARE PROVIDER AND THE DEPARTMENT
 SHALL  MONITOR  THE  PRIOR  AUTHORIZATION  PROCESS  UNDER  A   QUALIFIED
 PRESCRIPTION DRUG SYSTEM FOR PRESCRIBING PATTERNS WHICH ARE SUSPECTED OF
 ENDANGERING  THE HEALTH AND SAFETY OF THE PATIENT OR WHICH DEMONSTRATE A
 LIKELIHOOD OF FRAUD OR ABUSE. THE MANAGED CARE PROVIDER AND THE  DEPART-

 A. 2843                             5
 
 MENT SHALL TAKE ANY AND ALL ACTIONS OTHERWISE PERMITTED BY LAW TO INVES-
 TIGATE SUCH PRESCRIBING PATTERNS, TO TAKE REMEDIAL ACTION AND TO ENFORCE
 APPLICABLE FEDERAL AND STATE LAWS.
   7. USE OF PREFERRED DRUG PROGRAM. THE COMMISSIONER MAY CONTRACT WITH A
 MANAGED CARE PROVIDER FOR THE PROVIDER TO USE THE PREFERRED DRUG PROGRAM
 TO  PROVIDE PRIOR AUTHORIZATION UNDER THE MANAGED CARE PROVIDER'S QUALI-
 FIED PRESCRIPTION DRUG SYSTEM. THE CONTRACT SHALL INCLUDE TERMS REQUIRED
 BY THE COMMISSIONER TO MAXIMIZE SAVINGS  TO  THE  MEDICAID  PROGRAM  AND
 PROTECT  THE HEALTH AND INTERESTS OF THE MANAGED CARE PROVIDER'S PARTIC-
 IPANTS. THE CONTRACT SHALL PROVIDE WHETHER THE  PREFERRED  DRUG  PROGRAM
 SHALL  USE  THE  MANAGED CARE PROVIDER'S LISTS OF PREFERRED AND NON-PRE-
 FERRED DRUGS OR  THE  PREFERRED  DRUG  LIST  UNDER  THE  PREFERRED  DRUG
 PROGRAM, WITH RESPECT TO WHETHER PRIOR AUTHORIZATION IS REQUIRED.
   § 2. Subdivisions 25 and  25-a of section 364-j of the social services
 law are REPEALED.
   §  3. Section 2511 of the public health law is amended by adding a new
 subdivision 22 to read as follows:
   22. PAYMENT FOR PRESCRIPTION DRUGS.  PAYMENT  FOR  PRESCRIPTION  DRUGS
 SHALL  BE  INCLUDED IN THE PAYMENTS FOR SERVICES OR SUPPLIES PROVIDED BY
 THE APPROVED ORGANIZATION, PROVIDED THAT THE PLAN PAYS FOR  PRESCRIPTION
 DRUGS  UNDER  A  QUALIFIED  PRESCRIPTION DRUG SYSTEM UNDER SECTION THREE
 HUNDRED SIXTY-FIVE-I OF THE SOCIAL SERVICES LAW. EVERY PRESCRIPTION DRUG
 ELIGIBLE FOR REIMBURSEMENT UNDER THIS ARTICLE PRESCRIBED IN RELATION  TO
 A  SERVICE  PROVIDED  BY  THE  APPROVED  ORGANIZATION  SHALL BE EITHER A
 PREFERRED OR NON-PREFERRED DRUG UNDER THE  QUALIFIED  PRESCRIPTION  DRUG
 SYSTEM. IF THE APPROVED ORGANIZATION DOES NOT PAY FOR PRESCRIPTION DRUGS
 UNDER   A   QUALIFIED   PRESCRIPTION   DRUG  SYSTEM,  THEN  PAYMENT  FOR
 PRESCRIPTION DRUGS FOR THE APPROVED ORGANIZATION'S PATIENTS SHALL NOT BE
 INCLUDED IN SUCH PAYMENTS AND PRESCRIPTION DRUGS SHALL BE  PROVIDED  FOR
 THE  APPROVED  ORGANIZATION'S  PARTICIPANTS  UNDER  THE  PREFERRED  DRUG
 PROGRAM.
   § 4. Subdivision 11 of section  270  of  the  public  health  law,  as
 amended  by  section 2-a of part C of chapter 58 of the laws of 2008, is
 amended to read as follows:
   11. "State public health plan" means the  medical  assistance  program
 established  by  title eleven of article five of the social services law
 (referred to in this article as "Medicaid"), the elderly  pharmaceutical
 insurance  coverage program established by title three of article two of
 the elder law (referred to in this article as "EPIC"), [and  the  family
 health  plus  program established by section three hundred sixty-nine-ee
 of the social services law to the extent that section provides that  the
 program  shall  be subject to this article], AND THE CHILD HEALTH INSUR-
 ANCE PLAN UNDER TITLE ONE-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER.
   § 5. Section 272 of the public health law is amended by adding  a  new
 subdivision 12 to read as follows:
   12.  NO PRIOR AUTHORIZATION SHALL BE REQUIRED UNDER THE PREFERRED DRUG
 PROGRAM FOR:
   (A) ATYPICAL ANTI-PSYCHOTICS; (B) ANTI-DEPRESSANTS; (C)  ANTI-RETROVI-
 RALS  USED  IN THE TREATMENT OF HIV/AIDS OR HEPATITIS C; (D) ANTI-REJEC-
 TION DRUGS USED IN THE TREATMENT OF ORGAN AND  TISSUE  TRANSPLANTS;  AND
 (E)  ANY  OTHER  THERAPEUTIC  CLASS FOR THE TREATMENT OF MENTAL ILLNESS,
 HIV/AIDS OR HEPATITIS C, RECOMMENDED BY THE BOARD AND  APPROVED  BY  THE
 COMMISSIONER UNDER THIS SECTION.
   § 6. This act shall take effect on the one hundred eightieth day after
 it  shall  become a law; provided, however, that section two of this act
 shall take effect one year after  this  act  shall  become  a  law;  and

 A. 2843                             6
 
 provided further, that the commissioner of health is immediately author-
 ized  and  directed to take actions necessary to implement this act when
 it takes effect.