BILL NUMBER: S8981

SPONSOR: HARCKHAM
 
TITLE OF BILL:

An act to amend the public health law and the insurance law, in relation
to prohibiting health insurers from requiring prior authorization for
anti-retroviral medication used to treat and prevent HIV infection

 
PURPOSE::

Prohibits health insurers from requiring prior authorization for antire-
troviral medication used to treat and prevent HIV infection

 
SUMMARY OF PROVISIONS:

Section 1 amends section 4406-c of the public health law by requiring
health care plans which provide prescription drug coverage shall not
require a prior authorization determination for anti-retroviral medica-
tion used to treat and prevent HIV infection. Nothing in this subdivi-
sion shall prohibit a health care plan from denying a claim for such
services if the services are subsequently determined not medically
              

necessary.

Section 2 amends section 3217-b of the insurance law which provides that
an insurer that provides prescription drug coverage shall not require a
prior authorization determination for anti-retroviral medication used to
treat and 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.

Section 3 amends section 4325 of the insurance law by providing that a
corporation organized under this article that provides prescription drug
coverage shall not require a prior authorization determination for
antiretroviral medication used to treat and prevent HIV infection. Noth-
ing 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.

Section 4 provides the effective date

 
JUSTIFICATION::

Anti-retroviral medications are currently used to maintain symptoms
associated with human immunodeficiency virus (HIV). Persons diagnosed
with HIV are advised to start antiretroviral therapy as soon as possible
to minimize damage to their immune systems and their risk of developing
AIDS. This bill seeks to remove preauthorizations for health care plans
which provide prescription drug coverage for anti-retroviral medication
used to treat and prevent HIV infection.  Such change would allow
persons diagnosed with HIV to receive their anti-retroviral medications
without having to wait out the preauthorization process.

 
LEGISLATIVE HISTORY::

This is a new bill.

 
FISCAL IMPLICATIONS:

None to the State.

 
EFFECTIVE DATE:
This act shall take effect on the one hundred eightieth day after it
shall have become a law.