S 5534: Prohibits Medicaid service providers from requiring prior authorization for antiretroviral prescription drugs for the treatment or prevention of the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS).

  
  STATE OF NEW YORK ________________________________________________________________________ 5534 2025-2026 Regular Sessions  IN SENATE February 24, 2025 ___________ Introduced by Sen. HOYLMAN-SIGAL -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the social services law and the public health law, in relation to prohibiting Medicaid from requiring prior authorization for HIV medication The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph (g-1) of subdivision 2 of section 365-a of the 2 social services law, as amended by section 9 of part D of chapter 57 of 3 the laws of 2017, is amended to read as follows: 4 (g-1) drugs provided on an in-patient basis, those drugs contained on 5 the list established by regulation of the commissioner of health pursu- 6 ant to subdivision four of this section, and those drugs which may not 7 be dispensed without a prescription as required by section sixty-eight 8 hundred ten of the education law and which the commissioner of health 9 shall determine to be reimbursable based upon such factors as the avail- 10 ability of such drugs or alternatives at low cost if purchased by a 11 medicaid recipient, or the essential nature of such drugs as described 12 by such commissioner in regulations, provided, however, that such drugs, 13 exclusive of long-term maintenance drugs, shall be dispensed in quanti- 14 ties no greater than a thirty day supply or one hundred doses, whichever 15 is greater; provided further that the commissioner of health is author- 16 ized to require prior authorization for any refill of a prescription 17 when more than a ten day supply of the previously dispensed amount 18 should remain were the product used as normally indicated, or in the 19 case of a controlled substance, as defined in section thirty-three 20 hundred two of the public health law, when more than a seven day supply 21 of the previously dispensed amount should remain were the product used 22 as normally indicated; provided further that the commissioner of health 23 is authorized to require prior authorization of prescriptions of opioid 24 analgesics in excess of four prescriptions in a thirty-day period in EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD00020-01-5 
 S. 5534 2 1 accordance with section two hundred seventy-three of the public health 2 law; provided further that the commissioner of health shall not require 3 prior authorization of antiretroviral prescription drugs for the treat- 4 ment or prevention of the human immunodeficiency virus (HIV) or acquired 5 immunodeficiency syndrome (AIDS); medical assistance shall not include 6 any drug provided on other than an in-patient basis for which a recipi- 7 ent is charged or a claim is made in the case of a prescription drug, in 8 excess of the maximum reimbursable amounts to be established by depart- 9 ment regulations in accordance with standards established by the secre- 10 tary of the United States department of health and human services, or, 11 in the case of a drug not requiring a prescription, in excess of the 12 maximum reimbursable amount established by the commissioner of health 13 pursuant to paragraph (a) of subdivision four of this section; 14 § 2. Section 364-j of the social services law is amended by adding a 15 new subdivision 26-d to read as follows: 16 26-d. Managed care providers shall not require prior authorization for 17 any antiretroviral prescription drugs for the treatment or prevention of 18 the human immunodeficiency virus (HIV) or acquired immunodeficiency 19 syndrome (AIDS). 20 § 3. Section 273 of the public health law is amended by adding a new 21 subdivision 11 to read as follows: 22 11. Prior authorization shall not be required for antiretroviral 23 prescription drugs prescribed to a person in a state public health plan 24 for the treatment or prevention of the human immunodeficiency virus 25 (HIV) or acquired immunodeficiency syndrome (AIDS). 26 § 4. This act shall take effect on the one hundred eightieth day after 27 it shall have become a law; provided, however, that the amendments to 28 section 364-j of the social services law made by section two of this act 29 shall not affect the repeal of such section and shall be deemed repealed 30 therewith.