Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
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Jan 03, 2018 |
referred to health |
Jun 01, 2017 |
referred to health |
Senate Bill S6541
2017-2018 Legislative Session
Sponsored By
(R, C, IP) Senate District
Archive: Last Bill Status - In Senate Committee Health Committee
- Introduced
-
- In Committee Assembly
- In Committee Senate
-
- On Floor Calendar Assembly
- On Floor Calendar Senate
-
- Passed Assembly
- Passed Senate
- Delivered to Governor
- Signed By Governor
Actions
co-Sponsors
(D) 32nd Senate District
2017-S6541 (ACTIVE) - Details
2017-S6541 (ACTIVE) - Sponsor Memo
BILL NUMBER: S6541 TITLE OF BILL : An act to amend the social services law, in relation to coverage for certain prescription drugs; and to repeal certain provisions of such law relating thereto PURPOSE: : To clarify that "prescriber prevails" provisions under Medicaid managed care for certain classes of drugs shall be conducted as it currently is for fee-for-service Medicaid recipients, with exceptions. SUMMARY OF PROVISIONS: : Section 1 of the bill Amends Social Services Law § 364-j, subdivision 25 to obligate a Medicaid managed care plan to cover a drug benefit when, in the prescriber's reasonable professional judgment, the prescription is medically necessary and warranted. The exceptions are in the instance when a drug is required by the Medicaid program to be filled with a generic substitute and the prescriber has marked "dispense as written;" or when the prescription is related to a use not supported by the FDA-approved label, or official compendia or formularies. The bill also consolidates into subdivision 25 the drug classes listed in subdivision 25-a, and repeals subdivision 25-a. JUSTIFICATION: :
2017-S6541 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 6541 2017-2018 Regular Sessions I N S E N A T E June 1, 2017 ___________ Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the social services law, in relation to coverage for certain prescription drugs; and to repeal certain provisions of such law relating thereto THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subdivision 25 of section 364-j of the social services law, as added by section 55 of part D of chapter 56 of the laws of 2012, is amended to read as follows: 25. [Effective January first, two thousand thirteen, notwithstanding] NOTWITHSTANDING any provision of law to the contrary, managed care providers shall cover medically necessary prescription drugs in the ANTI-DEPRESSANT, ANTI-RETROVIRAL, ANTIREJECTION, SEIZURE, EPILEPSY, ENDOCRINE, HEMATOLOGIC, IMMUNOLOGIC AND atypical antipsychotic therapeu- tic [class] CLASSES, including non-formulary drugs, upon [demonstration] DETERMINATION by THE PRESCRIBER UNDER THIS SUBDIVISION. IF the prescri- ber, after consulting with the managed care provider, DETERMINES that such drugs, in the prescriber's reasonable professional judgment, are medically necessary and warranted, THE PRESCRIBER'S DETERMINATION SHALL BE FINAL. HOWEVER, THE PRESCRIBER'S DETERMINATION SHALL NOT BE FINAL: (A) WHERE THE DRUG APPROVED BY THE MANAGED CARE PROVIDER IS A GENERIC DRUG SUBJECT TO SUBPARAGRAPH (I) OF PARAGRAPH (A-1) OF SUBDIVISION FOUR OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS ARTICLE (MANDATORY GENERIC SUBSTITUTION), AND THE PRESCRIBER HAS INDICATED THAT THE PRESCRIPTION SHALL BE DISPENSED AS WRITTEN; OR (B) IF IT IS FOR THE USE OF A DRUG THAT IS NOT CONSISTENT WITH FOOD AND DRUG ADMINISTRATION-APPROVED LABEL- ING OR SUPPORTED BY ONE OR MORE OFFICIAL COMPENDIA REFERENCES, INCLUD- ING, BUT NOT LIMITED TO, THE AMERICAN HOSPITAL FORMULARY SERVICE (AHFS), THE DRUGDEX DRUG INFORMATION SYSTEM AND THE UNITED STATES PHARMACOPEIA. EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD07092-02-7
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