Bill Text: NY S04721 | 2015-2016 | General Assembly | Amended
Bill Title: Directs the commissioner of health and superintendent of financial services to establish a standard prior authorization request for a utilization review of prescription drug coverage.
Spectrum: Partisan Bill (Republican 3-0)
Status: (Passed) 2016-11-14 - SIGNED CHAP.427 [S04721 Detail]
Download: New_York-2015-S04721-Amended.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 4721--A Cal. No. 1059 2015-2016 Regular Sessions I N S E N A T E April 10, 2015 ___________ Introduced by Sens. HANNON, LARKIN -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- reported favorably from said committee, ordered to first report, amended on first report, ordered to a second report and ordered reprinted, retaining its place in the order of second report AN ACT to amend the public health law and the insurance law, in relation to standards for prior authorization requests for a utilization review of prescription drug coverage THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Section 4903 of the public health law is amended by adding 2 a new subdivision 8 to read as follows: 3 8. THE COMMISSIONER, IN CONJUNCTION WITH THE SUPERINTENDENT OF FINAN- 4 CIAL SERVICES, SHALL DEVELOP STANDARDS FOR PRIOR AUTHORIZATION REQUESTS 5 TO BE UTILIZED BY ALL HEALTH CARE PLANS FOR THE PURPOSES OF SUBMITTING A 6 REQUEST FOR A UTILIZATION REVIEW DETERMINATION FOR COVERAGE OF 7 PRESCRIPTION DRUG BENEFITS UNDER THIS ARTICLE. THE DEPARTMENT AND THE 8 DEPARTMENT OF FINANCIAL SERVICES, IN DEVELOPMENT OF THE STANDARDS, SHALL 9 TAKE INTO CONSIDERATION EXISTING ELECTRONIC PRIOR AUTHORIZATION STAND- 10 ARDS INCLUDING NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS (NCPDP) 11 ELECTRONIC PRIOR AUTHORIZATION STANDARD TRANSACTIONS. 12 S 2. Section 4903 of the insurance law is amended by adding a new 13 subsection (h) to read as follows: 14 (H) THE SUPERINTENDENT, IN CONJUNCTION WITH THE COMMISSIONER OF 15 HEALTH, SHALL DEVELOP STANDARDS FOR PRIOR AUTHORIZATION REQUESTS TO BE 16 UTILIZED BY ALL HEALTH CARE PLANS FOR THE PURPOSES OF SUBMITTING A 17 REQUEST FOR A UTILIZATION REVIEW DETERMINATION FOR COVERAGE OF 18 PRESCRIPTION DRUG BENEFITS UNDER THIS ARTICLE. THE DEPARTMENT AND THE 19 DEPARTMENT OF HEALTH, IN DEVELOPMENT OF THE STANDARDS, SHALL TAKE INTO 20 CONSIDERATION EXISTING ELECTRONIC PRIOR AUTHORIZATION STANDARDS INCLUD- 21 ING NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS (NCPDP) ELECTRONIC 22 PRIOR AUTHORIZATION STANDARD TRANSACTIONS. 23 S 3. This act shall take effect immediately. EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD04038-03-5