Senate Bill S10458

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10458
 
                             I N  S E N A T E
 
                               May 15, 2026
                                ___________
 
 Introduced by Sens. BOTTCHER, JACKSON -- read twice and ordered printed,
   and when printed to be committed to the Committee on Health
 
 AN  ACT  to  amend the social services law and the public health law, in
   relation to prohibiting Medicaid from  requiring  prior  authorization
   for HIV medication
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraph (g-1) of subdivision 2 of section  365-a  of  the
 social  services law, as amended by section 9 of part D of chapter 57 of
 the laws of 2017, is amended to read as follows:
   (g-1) drugs provided on an in-patient basis, those drugs contained  on
 the  list established by regulation of the commissioner of health pursu-
 ant to subdivision four of this section, and those drugs which  may  not
 be  dispensed  without a prescription as required by section sixty-eight
 hundred ten of the education law and which the  commissioner  of  health
 shall determine to be reimbursable based upon such factors as the avail-
 ability  of  such  drugs  or  alternatives at low cost if purchased by a
 medicaid recipient, or the essential nature of such drugs  as  described
 by such commissioner in regulations, provided, however, that such drugs,
 exclusive  of long-term maintenance drugs, shall be dispensed in quanti-
 ties no greater than a thirty day supply or one hundred doses, whichever
 is greater; provided further that the commissioner of health is  author-
 ized  to  require  prior  authorization for any refill of a prescription
 when more than a ten day  supply  of  the  previously  dispensed  amount
 should  remain  were  the  product used as normally indicated, or in the
 case of a controlled  substance,  as  defined  in  section  thirty-three
 hundred  two of the public health law, when more than a seven day supply
 of the previously dispensed amount should remain were the  product  used
 as  normally indicated; provided further that the commissioner of health
 is authorized to require prior authorization of prescriptions of  opioid
 analgesics  in  excess  of  four prescriptions in a thirty-day period in
 accordance with section two hundred seventy-three of the  public  health
 law;  PROVIDED FURTHER THAT THE COMMISSIONER OF HEALTH SHALL NOT REQUIRE
 PRIOR AUTHORIZATION OF ANTIRETROVIRAL PRESCRIPTION DRUGS FOR THE  TREAT-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00020-01-5
 S. 10458                            2
 
 MENT OR PREVENTION OF THE HUMAN IMMUNODEFICIENCY VIRUS (HIV) OR ACQUIRED
 IMMUNODEFICIENCY  SYNDROME  (AIDS); medical assistance shall not include
 any drug provided on other than an in-patient basis for which a  recipi-
 ent is charged or a claim is made in the case of a prescription drug, in
 excess  of the maximum reimbursable amounts to be established by depart-
 ment regulations in accordance with standards established by the  secre-
 tary  of  the United States department of health and human services, or,
 in the case of a drug not requiring a prescription,  in  excess  of  the
 maximum  reimbursable  amount  established by the commissioner of health
 pursuant to paragraph (a) of subdivision four of this section;
   § 2. Section 364-j of the social services law is amended by  adding  a
 new subdivision 26-d to read as follows:
   26-D. MANAGED CARE PROVIDERS SHALL NOT REQUIRE PRIOR AUTHORIZATION FOR
 ANY ANTIRETROVIRAL PRESCRIPTION DRUGS FOR THE TREATMENT OR PREVENTION OF
 THE  HUMAN  IMMUNODEFICIENCY  VIRUS  (HIV)  OR ACQUIRED IMMUNODEFICIENCY
 SYNDROME (AIDS).
   § 3. Section 273 of the public health law is amended by adding  a  new
 subdivision 11 to read as follows:
   11.  PRIOR  AUTHORIZATION  SHALL  NOT  BE  REQUIRED FOR ANTIRETROVIRAL
 PRESCRIPTION DRUGS PRESCRIBED TO A PERSON IN A STATE PUBLIC HEALTH  PLAN
 FOR  THE  TREATMENT  OR  PREVENTION  OF THE HUMAN IMMUNODEFICIENCY VIRUS
 (HIV) OR ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS).
   § 4. This act shall take effect on the one hundred eightieth day after
 it shall have become a law; provided, however, that  the  amendments  to
 section 364-j of the social services law made by section two of this act
 shall not affect the repeal of such section and shall be deemed repealed
 therewith.