Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|
---|---|
Jan 08, 2020 |
referred to health |
Feb 26, 2019 |
print number 1794a |
Feb 26, 2019 |
amend and recommit to health |
Jan 16, 2019 |
referred to health |
Senate Bill S1794A
2019-2020 Legislative Session
Sponsored By
(D, WF) 33rd 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
Bill Amendments
2019-S1794 - Details
2019-S1794 - Sponsor Memo
BILL NUMBER: S1794 SPONSOR: RIVERA 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
2019-S1794 - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 1794 2019-2020 Regular Sessions I N S E N A T E January 16, 2019 ___________ Introduced by Sen. RIVERA -- 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 TITLE (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. LBD03448-02-9
2019-S1794A (ACTIVE) - Details
2019-S1794A (ACTIVE) - Sponsor Memo
BILL NUMBER: S1794A SPONSOR: RIVERA 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
2019-S1794A (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 1794--A 2019-2020 Regular Sessions I N S E N A T E January 16, 2019 ___________ Introduced by Sen. RIVERA -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee 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 TITLE (MANDATORY GENERIC SUBSTITUTION), AND EVEN IF 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-AP- PROVED LABELING OR SUPPORTED BY ONE OR MORE OFFICIAL COMPENDIA REFER- ENCES, INCLUDING, BUT NOT LIMITED TO, THE AMERICAN HOSPITAL FORMULARY EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted.
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