Bill Text: NY A02799 | 2019-2020 | General Assembly | Amended

Bill Title: Provides for coverage for certain medically necessary prescription drugs in Medicaid managed care programs.

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Introduced) 2019-02-15 - print number 2799a [A02799 Detail]

Download: New_York-2019-A02799-Amended.html

                STATE OF NEW YORK
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                    January 25, 2019
        Introduced by M. of A. GOTTFRIED, RODRIGUEZ -- read once and referred to
          the  Committee  on Health -- reported and referred to the Committee on
          Ways  and  Means  --  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:
     1    Section 1. Subdivision 25 of section 364-j of the social services law,
     2  as added by section 55 of part D of chapter 56 of the laws of  2012,  is
     3  amended to read as follows:
     4    25.  [Effective January first, two thousand thirteen, notwithstanding]
     5  Notwithstanding any provision of  law  to  the  contrary,  managed  care
     6  providers  shall  cover  medically  necessary  prescription drugs in the
     7  anti-depressant,  anti-retroviral,  antirejection,  seizure,   epilepsy,
     8  endocrine, hematologic, immunologic and atypical antipsychotic therapeu-
     9  tic [class] classes, including non-formulary drugs, upon [demonstration]
    10  determination  by the prescriber under this subdivision. If the prescri-
    11  ber, after consulting with the managed care  provider,  determines  that
    12  such  drugs,  in  the prescriber's reasonable professional judgment, are
    13  medically necessary and warranted, the prescriber's determination  shall
    14  be  final.  However,  the prescriber's determination shall not be final:
    15  (a) where the drug approved by the managed care provider  is  a  generic
    16  drug  subject to subparagraph (i) of paragraph (a-1) of subdivision four
    17  of section three hundred sixty-five-a of this title  (mandatory  generic
    18  substitution),  and  even  if  the  prescriber  has  indicated  that the
    19  prescription shall be dispensed as written; or (b) if it is for the  use
    20  of  a  drug that is not consistent with food and drug administration-ap-
    21  proved labeling or supported by one or more  official  Compendia  refer-
    22  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.

        A. 2799--A                          2
     1  Service (AHFS), the DRUGDEX  Drug  Information  System  and  the  United
     2  States Pharmacopeia.
     3    §  2.  Subdivision 25-a of section 364-j of the social services law is
     4  REPEALED.
     5    § 3. This act shall take effect on the sixtieth  day  after  it  shall
     6  have become a law; provided that effective immediately, the commissioner
     7  of  health  may  make  regulations  and  take other actions necessary to
     8  implement this act on that date; and provided, further, that the  amend-
     9  ments to section 364-j of the social services law made by section one of
    10  this act shall not affect the repeal of such section and shall be deemed
    11  repealed therewith.