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.