Prohibits medicaid's use of any prior approval or preferred drug list requirement for AIDS, HIV, infection, or hepatitis C.
TITLE OF BILL: An act to amend the social services law, in relation to establishing a prohibition on prior approval or preferred drug list requirements for certain drugs used to treat AIDS, HIV infection or hepatitis C
PURPOSE: To prohibit prior approval or preferred drug list requirements for certain drugs used to treat AIDS, HIV infection, or hepatitis C.
SUMMARY OF PROVISIONS: Section 1 prohibits prior authorization or preferred drug list program requirements for prescription drugs deemed to be medically necessary for the treatment and prevention of AIDS, HIV infection and hepatitis C. Section 2 is the severability clause.
JUSTIFICATION: Hepatitis C is rapidly emerging as one of New York's most significant public health issues. Currently, there are approximately 342,000 New Yorkers living with acute or chronic Hepatitis C and approximately 40,000 New Yorkers living with co-infection of HIV and Hepatitis C. Of this 40,000 it is estimated that 43% are African American and 29% are Hispanic. For these New Yorkers, hope lies in early treatment. Early diagnosis, early treatment and early access to Hepatitis C drugs are essential to the long-term health of the patient. The use of Hepatitis C drugs in the early stages of the virus, not only reduces the likelihood that a patient will spread the virus, but also reduces the likelihood that a patient will require an expensive liver transplant. The establishment of a prohibition on prior approval or preferred drug list requirements for certain AIDS, HIV infection and Hepatitis C drugs will help prevent the possibility of a future barrier to drug treatment and will help put the patient on a faster track to wellness.
LEGISLATIVE HISTORY: 01/09/08 REFERRED TO SOCIAL SERVICES, CHILDREN AND FAMILIES
FISCAL IMPLICATIONS: To be determined.
EFFECTIVE DATE: This act shall take effect on the first of January next succeeding the date on which it shall have become a law.
STATE OF NEW YORK ________________________________________________________________________ 564 2011-2012 Regular Sessions IN SENATE (PREFILED) January 5, 2011 ___________Introduced by Sen. ROBACH -- 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 establishing a prohibition on prior approval or preferred drug list requirements for certain drugs used to treat AIDS, HIV infection or hepatitis C THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. The opening paragraph of subdivision 2 of section 365-a of the social services law, as amended by chapter 41 of the laws of 1992, is amended and a new subdivision 10 is added to read as follows: "Medical assistance" shall mean payment of part or all of the cost of medically necessary medical, dental and remedial care, services and supplies, as authorized in this title or the regulations of the depart- ment, which are necessary to prevent, diagnose, correct or cure condi- tions in the person that cause acute suffering, endanger life, result in illness or infirmity, interfere with such person's capacity for normal activity, or threaten some significant handicap and which are furnished an eligible person in accordance with this title and the regulations of the department. Such care, services and supplies shall include the following medical care, services and supplies, together with such medical care, services and supplies provided for in subdivisions three, four and five of this section, and such medical care, services and supplies as are authorized in the regulations of the department, NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, SUBJECT TO THE PROVISIONS OF SUBDIVISION TEN OF THIS SECTION: 10. (A) UNLESS REQUIRED BY FEDERAL LAW AND REGULATION AS A CONDITION OF QUALIFYING FOR FEDERAL FINANCIAL PARTICIPATION IN THE MEDICAID PROGRAM, THE DEPARTMENT OTHERWISE NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, SHALL NOT RESTRICT BY PRIOR AUTHORIZATION OR PREFERRED DRUG LIST PROGRAM REQUIREMENT ANY PRESCRIPTION DRUG, INCLUDED IN CERTAINEXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01989-01-1 S. 564 2
THERAPEUTIC DRUG CLASSES, AS PRESCRIBED AND DETERMINED BY A PRESCRIBING PRACTITIONER LICENSED BY THE STATE, TO BE MEDICALLY NECESSARY FOR THE TREATMENT AND PREVENTION OF AIDS, HIV INFECTION, AND HEPATITIS C. (B) THERAPEUTIC CLASSES CONTAINING PRESCRIPTION DRUGS WHICH SHALL BE EXCLUDED FROM ANY PRIOR AUTHORIZATION OR PREFERRED DRUG LIST PROGRAM REQUIREMENT PROVISIONS SHALL INCLUDE THE FOLLOWING: (1) ANTI-RETROVIRAL MEDICATIONS, INCLUDING BUT NOT LIMITED TO PROTEASE INHIBITORS, NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS, NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS, ANTI-VIRALS, AND FUSION INHIBITORS PRESCRIBED FOR THE TREATMENT OF AIDS OR HIV INFECTION. (2) IMMUNOMODULATORS AND HEPATITIS C-SPECIFIC ANTIVIRAL DRUGS PRESCRIBED FOR THE TREATMENT OF HEPATITIS C. S 2. Severability. If any clause, sentence, paragraph, section or part of this act shall be adjudged by any court of competent jurisdiction to be invalid and after exhaustion of all further judicial review, the judgment shall not affect, impair or invalidate the remainder thereof, but shall be confined in its operation to the clause, sentence, para- graph, section or part of this act directly involved in the controversy in which the judgment shall have been rendered. S 3. This act shall take effect on the first of January next succeed- ing the date on which it shall have become a law; provided that the state commissioner of health is authorized to promulgate any and all rules and regulations and take any other measures necessary to implement this act on its effective date on or before such date.