Senate Bill S8423

                                 
BILL NUMBER: S8423

SPONSOR: HOYLMAN
 
TITLE OF BILL:

An act to amend the public health law, in relation to prohibiting the
preferred drug program from restricting or imposing delays in the
distribution of antiretroviral prescription drugs to certain persons; to
amend the social services law, in relation to prohibiting managed care
programs from restricting or imposing delays in the distribution of
antiretroviral prescription drugs to certain persons; and to amend the
insurance law, in relation to prohibiting insurers from restricting or
imposing delays in the distribution of antiretroviral prescription drugs
to certain persons

 
PURPOSE OR GENERAL IDEA OF BILL:

Prohibits insurers and public health plans from utilizing prior authori-
zation, step therapy, or other protocols that would restrict access to
antiretroviral drugs for the treatment or prevention of HIV or AIDS

 
SUMMARY OF PROVISIONS:
              

Section one prohibits the utilization of prior authorization, step ther-
apy or any other protocol that would restrict or delay the dispensing of
an antiretroviral drug for the treatment or prevention of HIV or AIDS in
the preferred drug program.

Section two prohibits Medicaid managed care plans from utilizing prior
authorization, step therapy or any other protocol that would restrict or
delay the dispensing of an antiretroviral drug for the treatment of HIV
or AIDS.

Sections three through five prohibit insurance policies, group or blan-
ket insurance plans, medical indemnity corporation, hospital service
corporations or a health service corporation that provide coverage for
antiretroviral drugs for the treatment of HIV or AIDS from subjecting
these drugs to prior authorization, step therapy, or other protocols
that would restrict or delay the dispensing of the drug.

Section six is the effective date.

 
JUSTIFICATION:

The "Ending the Epidemic" blueprint and subsequent progress report note
that providing better, more immediate access to antiretroviral drugs is
a key tool in fighting the AIDS epidemic.Patient needs vary with each
individual and health care providers consider a broad range of factors
when selecting treatments including the patient's drug resistance
profile, comorbidities, interactions with other medications, and pill
burden, in order to determine the most appropriate treatment. A person
living with HIV who is on effective HIV treatment can live a long and
health life and have effectively no risk of sexually transmitting HIV to
others. Additionally, a person at risk for HIV who is on effective HIV
prevention medication can reduce their risk of getting HIV by 99% when
taking the medication as prescribed.

New York enacted an Antiretroviral (ARV) protected class law in 2005.
The 2011 final enacted state budget carved the drug benefit out of fee-
for-service and into managed care, and removed statutory protections for
ARVs and other drugs, leaving the HIV community with restricted access
and life-threatening delays. Because these protections were rolled back,
insurers now use protocols such as prior authorization or fail first
(step therapy) protocols in order to minimize prescription drug costs.
These protocols have the effect of delaying access to these critically
important, time-sensitive drugs which are particularly harmful for indi-
viduals who are currently living with, or seeking to prevent HIV
infection.

Restricting access to these life-saving medications undermines the
relationship between a healthcare provider and their patient and puts up
unnecessary roadblocks to prevention and treatment. Specifically with
HIV treatment, the ability for the patient and medical professional to
rapidly switch antiretroviral medications is key to effectively treat-
ing, and stopping the spread of HIV and AIDS.

Patients should have open access to all Single Tablet Regimens (STRs) to
fully benefit from current and future advances in HIV therapy. A large
body of evidence demonstrates that individuals on STR's have higher
levels of adherence to HIV treatment, which improves health outcomes,
lowers the risk of hospitalization and reduces overall healthcare costs.
Studies show that individuals on STRs within the Veterans Affairs health
system, had 46% fewer hospitalizations compared to patients on Multi-ta-
blet Regimens (MTRs) and were 21% more likely to have undetectable
levels of HIV in the body. Open access to appropriate HIV prevention and
treatment medication for HIV will also support health equity by ensuring
that all New Yorkers have their treatment needs met regardless of their
insurance plan.This bill will ensure that these important anti-retrovi-
ral medications are readily available to patients and not subject to
procedural delays so that patients can start an HIV treatment regimen as
soon as they are diagnosed or exposed to possible infection.

 
PRIOR LEGISLATIVE HISTORY:

New Bill

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

None.

 
EFFECTIVE DATE:
This act shall take effect on the first of January next succeeding when
it becomes a law.