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

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Introduced - Dead) 2020-01-08 - referred to ways and means [A02799 Detail]

Download: New_York-2019-A02799-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          2799
                               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
        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 article (mandatory generic
    18  substitution), and the prescriber has indicated  that  the  prescription
    19  shall  be  dispensed  as  written; or (b) if it is for the use of a drug
    20  that is not consistent with food and drug administration-approved label-
    21  ing or supported by one or more official Compendia  references,  includ-
    22  ing, but not limited to, the American Hospital Formulary Service (AHFS),
    23  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.
                                                                   LBD03448-01-9
        A. 2799                             2
     1    §  2.  Subdivision 25-a of section 364-j of the social services law is
     2  REPEALED.
     3    §  3.  This  act  shall take effect on the sixtieth day after it shall
     4  have become a law; provided that effective immediately, the commissioner
     5  of health may make regulations  and  take  other  actions  necessary  to
     6  implement  this act on that date; and provided, further, that the amend-
     7  ments to section 364-j of the social services law made by section one of
     8  this act shall not affect the repeal of such section and shall be deemed
     9  repealed therewith.