BILL NUMBER: S5374

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 antiretroviral 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 antiretroviral 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 states the effective date

 
JUSTIFICATION:

According to the New York State Department of Health (DOH), there are
103,900 New Yorkers living with human immunodeficiency virus (HIV), many
of whom rely on antiretroviral medications to manage their symptoms.
Countless individuals regularly rely on antiretroviral medications to
prevent becoming infected with HIV.

Time is a crucial factor in the efficacy of these medications. 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. After being exposed to HIV, an individual must receive
antiretroviral medication within seventy-two hours to prevent infection.
Preauthorization can take days, putting the health of those infected
with and those exposed to HIV at risk.

Administrative costs of the preauthorization process can be high, which
can place a financial burden on healthcare providers. This legislation
will ensure New Yorkers living with HIV are able to receive their medi-
cation in a timely manner, and that healthcare providers are able to
give their HIV-positive patients the best care they possibly can.

 
LEGISLATIVE HISTORY:

2021-2022: S8981 - Died in Health

 
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.