What's happening
This bill requires managed care providers to cover medically necessary prescription drugs in several therapeutic classes, making prescribers' determinations generally final with certain exceptions.
Why it matters
Reduces managed care “fail first” or step therapy barriers. by making prescribers’ decisions about medical necessity for key drug classes (like antidepressants, seizure meds, antiretrovirals, and more) generally final, shifting power from insurers to doctors and their patients.
Expands mandated coverage to more drug classes,. including not just mental health and HIV medications but also endocrine, hematologic, immunologic, and others—potentially improving treatment access for people with a range of chronic or complex conditions.
Includes important exceptions to prescriber authority. Insurers can still require generic substitution unless there’s a clinical reason not to, and can deny coverage if the drug use isn’t FDA-approved or supported by recognized medical references, aiming to balance patient access with cost controls and evidence-based medicine.
Repeals previous language that may have limited access or imposed additional restrictions,. streamlining the law and potentially accelerating patients’ access to the medications their clinicians believe are best for them.
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Who cares
Headline styles
Expand Medicaid Drug Coverage
Plain English, a few words. Used as the page title.
Sponsors
2 Co-sponsors
History
- Referred to ways and means
- Print number 2799a
- Amend and recommit to ways and means
- Reported referred to ways and means
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Expand Medicaid Drug Coverage
In Senate Committee · Health · Sponsor Gustavo Rivera
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2799--A
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 Assembly, do enact as follows:
Section 1. Subdivision 25 of section 364-j of the social services law, as added by section 55 of part D of chapter 56 of the laws of 2012, is amended to read as follows:
25. [Effective January first, two thousand thirteen, notwithstanding] Notwithstanding any provision of law to the contrary, managed care providers shall cover medically necessary prescription drugs in the anti-depressant, anti-retroviral, antirejection, seizure, epilepsy, endocrine, hematologic, immunologic and atypical antipsychotic therapeutic [class] classes, including non-formulary drugs, upon [demonstration] determination by the prescriber under this subdivision. If the prescriber, after consulting with the managed care provider, determines that such drugs, in the prescriber's reasonable professional judgment, are medically necessary and warranted, the prescriber's determination shall be final. However, the prescriber's determination shall not be final: (a) where the drug approved by the managed care provider is a generic drug subject to subparagraph (i) of paragraph (a-1) of subdivision four of section three hundred sixty-five-a of this title (mandatory generic substitution), and even if the prescriber has indicated that the prescription shall be dispensed as written; or (b) if it is for the use of a drug that is not consistent with food and drug administration-approved labeling or supported by one or more official Compendia references, 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.
LBD03448-04-9
A. 2799--A 2
Service (AHFS), the DRUGDEX Drug Information System and the United States Pharmacopeia.
§ 2. Subdivision 25-a of section 364-j of the social services law is REPEALED.
§ 3. This act shall take effect on the sixtieth day after it shall have become a law; provided that effective immediately, the commissioner of health may make regulations and take other actions necessary to implement this act on that date; and provided, further, that the amendments to section 364-j of the social services law made by section one of this act shall not affect the repeal of such section and shall be deemed repealed therewith.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.