S 5012: Prohibits health insurers, health care plans and HMOs from requiring prior authorization for anti-retroviral medication used to treat and prevent HIV infection.

  
  STATE OF NEW YORK ________________________________________________________________________ 5012 2025-2026 Regular Sessions  IN SENATE February 18, 2025 ___________ Introduced by Sens. HARCKHAM, WEBB -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the public health law and the insurance law, in relation to prohibiting health insurers from requiring prior authorization for anti-retroviral medication used to treat and prevent HIV infection The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 4406-c of the public health law is amended by 2 adding a new subdivision 14 to read as follows: 3 14. A health care plan which provides prescription drug coverage shall 4 not require a prior authorization determination for anti-retroviral 5 medication used to treat and prevent HIV infection. Nothing in this 6 subdivision shall prohibit a health care plan from denying a claim for 7 such services if the services are subsequently determined not medically 8 necessary. 9 § 2. Section 3217-b of the insurance law is amended by adding a new 10 subsection (p) to read as follows: 11 (p) An insurer which provides prescription drug coverage shall not 12 require a prior authorization determination for anti-retroviral medica- 13 tion used to treat and prevent HIV infection. Nothing in this subsection 14 shall prohibit an insurer from denying a claim for such services if the 15 services are subsequently determined not medically necessary. 16 § 3. Section 4325 of the insurance law is amended by adding a new 17 subsection (p) to read as follows: 18 (p) A corporation organized under this article which provides 19 prescription drug coverage shall not require a prior authorization 20 determination for anti-retroviral medication used to treat and prevent 21 HIV infection. Nothing in this subsection shall prohibit a corporation 22 organized under this article from denying a claim for such services if 23 the services are subsequently determined not medically necessary. 24 § 4. This act shall take effect on the one hundred eightieth day after 25 it shall have become a law. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD09739-01-5