What's happening
This bill prohibits health insurers in New York from requiring prior authorization for HIV prevention medication (pre-exposure prophylaxis).
Why it matters
Removes a major barrier to accessing HIV prevention. By eliminating prior authorization requirements, the bill makes it easier and faster for individuals to obtain pre-exposure prophylaxis (PrEP), which is a proven method for preventing HIV infection.
Could lead to earlier and more consistent use of PrEP. Without the administrative delays of prior authorization, people at risk for HIV may be more likely to start and stick with PrEP, potentially reducing new HIV transmissions in New York.
Retains safeguards against unnecessary prescriptions. The bill still allows insurers to deny claims if PrEP is found not to be medically necessary, balancing increased access with continued oversight to prevent inappropriate use.
Signals a public health priority for HIV prevention. Enacting this change shows a legislative commitment to removing systemic barriers and supporting public health efforts to end the HIV epidemic in the state.
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Who cares
Headline styles
End PreP Insurance Hurdles
Plain English, a few words. Used as the page title.
Sponsors
2 Co-sponsors
History
- Committed to rules
- Amended on third reading 6779a
- Advanced to third reading
- 2nd report cal.
- 1st report cal.422
- Referred to health
- Referred to rules
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.
End PrEP Authorization Delays
In Assembly Committee · Insurance · Sponsor Richard Gottfried
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
6779--A Cal. No. 422
2019-2020 Regular Sessions
IN SENATE
October 16, 2019
Introduced by Sens. HOYLMAN, JACKSON, RIVERA -- read twice and ordered printed, and when printed to be committed to the Committee on Rules -recommitted to the Committee on Health in accordance with Senate Rule
6, sec. 8 -- reported favorably from said committee, ordered to first and second report, ordered to a third reading, amended and ordered reprinted, retaining its place in the order of third reading
AN ACT to amend the public health law and the insurance law, in relation to prohibiting health insurers from requiring prior authorization for pre-exposure prophylaxis used to prevent HIV infection
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 4406-c of the public health law is amended by adding a new subdivision 11 to read as follows:
11. A health care plan which provides prescription drug coverage shall not require a prior authorization determination for pre-exposure prophylaxis used to prevent HIV infection. Nothing in this subdivision shall prohibit a health care plan from denying a claim for such services if the services are subsequently determined not medically necessary.
§ 2. Section 3217-b of the insurance law is amended by adding a new subsection (m) to read as follows:
(m) An insurer which provides prescription drug coverage shall not require a prior authorization determination for pre-exposure prophylaxis used to prevent HIV infection. Nothing in this subsection shall prohibit an insurer from denying a claim for such services if the services are subsequently determined not medically necessary.
§ 3. Section 4325 of the insurance law is amended by adding a new subsection (n) to read as follows:
(n) A corporation organized under this article which provides prescription drug coverage shall not require a prior authorization determination for pre-exposure prophylaxis used to prevent HIV infection. Nothing in this subsection shall prohibit a corporation
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD08766-05-0
S. 6779--A 2
organized under this article from denying a claim for such services if the services are subsequently determined not medically necessary.
§ 4. This act shall take effect on the one hundred eightieth day after it shall have become a law.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the public health law and the insurance law, in relation to prohibiting health insurers from requiring prior authorization for pre-exposure prophylaxis used to prevent HIV infection
Purpose or general idea of bill
To prohibit health insurers from requiring prior authorization for pre- exposure prophylaxis used to prevent HIV infection.
Summary of specific provisions
Section 1 of the bill adds a new subdivision 11 to § 4406-c of the public health law stating that a health care plan which provides prescription drug coverage shall not require prior authorization for pre-exposure prophylaxis used to prevent HIV infection.
§ 2 and § 3 if the bill amend the insurance law to prohibit prior authorization for pre-exposure prophylaxis used to prevent HIV infection. § 4 is the effective date.
Justification
The U.S. Preventive Services Task Force recommends that health care providers be encouraged to offer PrEP to patients at risk of HIV infection. This will significantly increase access to this important medication that prevents HIV infection.
New Yorkers at risk for HIV have faced barriers in accessing PrEP. Complaints to the NYS Department of Financial Services about health insurance plans "use of stringent prior authorization requirements and improper denials of coverage" resulted in the agency sending a December 2017 circular letter to all health insurers reiterating that "issuers offering prescription drug coverage must cover PrEP," that "such cover- age should be subject only to reasonable utilization management meas- ures" and that "no insured may be discriminate d against in the prescribing or coverage of medically necessary treatments."
Health care providers, adequately screening for well-known HIV risk factors with their patients, should be the only step needed to access PrEP. Passage of this legislation will result in fewer people contract- ing HIV.
Prior legislative history
New Bill
Fiscal implications
None to the State.
Effective date
180 days after it shall have become a law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.