Directs the commissioner of health to develop a standard prior prescription drug authorization request form for managed care providers

1 Co-sponsor

• William J. Larkin Jr.

BILL NUMBER:S7384A

Title of bill

An act to amend the social services law, in relation to directing the commissioner of health to develop a standard prior prescription drug authorization request form for managed care providers

Purpose

This bill directs the Department of Health to develop a standard prior authorization request form or forms for prescription drug benefits within Medicaid Managed Care.

Summary of provisions

The bill would add new subdivision 26 of section 364-j of the social services law, which would direct the Department of Health to develop a standard prior authorization request form or forms to be used by Medicaid managed care providers to determine coverage of prescription drug benefits.

Justification

The 2011-12 New York State Budget, as part of a comprehensive redesign of the Medicaid program, moved the overwhelming majority of prescription drug coverage from the Medicaid fee-for-service program into Medicaid Managed Care. As a result of this change, health care providers now have more than twenty formularies and prior authorization processes to contend with when writing prescriptions for their Medicaid patients. Navigating this system has proven to be a significant administrative burden for health care providers who are already stretched thin when providing critical safety net services to New York's most vulnerable populations.

This bill directs the Department of Health to develop a standard form or forms to be used for prior authorizations related to the prescription drug benefit within Medicaid Managed Care. By standardizing this process, health care providers will be relieved of a substantial administrative burden and will be better able to spend their time caring for patients.

Legislative history

New bill.

Fiscal implications

None.

Effective date

Immediately.