S T A T E O F N E W Y O R K
________________________________________________________________________
7281--A
2019-2020 Regular Sessions
I N A S S E M B L Y
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:
Section 1. Section 4406-c of the public health law is amended by
adding a new subdivision 11 to read as follows:
11. A HEALTH CARE PLAN WHICH PROVIDES PRESCRIPTION DRUG COVERAGE SHALL
NOT REQUIRE A PRIOR AUTHORIZATION DETERMINATION FOR PRE-EXPOSURE PROPHY-
LAXIS USED TO PREVENT HIV INFECTION. NOTHING IN THIS SUBDIVISION SHALL
PROHIBIT A HEALTH CARE PLAN FROM DENYING A CLAIM FOR SUCH SERVICES IF
THE SERVICES ARE SUBSEQUENTLY DETERMINED NOT MEDICALLY NECESSARY.
§ 2. Section 3217-b of the insurance law is amended by adding a new
subsection (m) to read as follows:
(M) AN INSURER WHICH PROVIDES PRESCRIPTION DRUG COVERAGE SHALL NOT
REQUIRE A PRIOR AUTHORIZATION DETERMINATION FOR PRE-EXPOSURE PROPHYLAXIS
USED TO PREVENT HIV INFECTION. NOTHING IN THIS SUBSECTION SHALL PROHIBIT
AN INSURER FROM DENYING A CLAIM FOR SUCH SERVICES IF THE SERVICES ARE
SUBSEQUENTLY DETERMINED NOT MEDICALLY NECESSARY.
§ 3. Section 4325 of the insurance law is amended by adding a new
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
(N) A CORPORATION ORGANIZED UNDER THIS ARTICLE WHICH PROVIDES
PRESCRIPTION DRUG COVERAGE SHALL NOT REQUIRE A PRIOR AUTHORIZATION
DETERMINATION FOR PRE-EXPOSURE PROPHYLAXIS USED TO PREVENT HIV
INFECTION. NOTHING IN THIS SUBSECTION SHALL PROHIBIT A CORPORATION
ORGANIZED UNDER THIS ARTICLE FROM DENYING A CLAIM FOR SUCH SERVICES IF
THE SERVICES ARE SUBSEQUENTLY DETERMINED NOT MEDICALLY NECESSARY.
§ 4. This act shall take effect on the one hundred eightieth day after
it shall have become a law.