BILL NUMBER: S1001A
SPONSOR: HOYLMAN-SIGAL
 
TITLE OF BILL:
An act to amend the insurance law, in relation to prohibiting insurers
from restricting or imposing delays in the distribution of antiretrovi-
ral prescription drugs to certain persons
 
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill is to prohibit insurers from utilizing prior
authorization that would restrict access to antiretroviral drugs for the
treatment or prevention of HIV or AIDS.
 
SUMMARY OF PROVISIONS:
This bill would prohibit health insurance policies that provides cover-
age for antiretroviral prescription drugs prescribed for the treatment
or prevention of the human immunodeficiency virus (HIV) or acquired
immunodeficiency syndrome (AIDS) from subjecting such drugs to prior
authorization.
 
JUSTIFICATION:
The "Ending the Epidemic" blueprint and subsequent progress report note
that providing better, more immediate access to antiretroviral drugs is
a key tool in fighting the AIDS epidemic. Patient needs vary with each
individual, and health care providers consider a broad range of factors
when selecting treatments including the patient's drug resistance
profile, comorbidities, interactions with other medications, and pill
burden, in order to determine the most appropriate treatment. A person
living with HIV who is on effective HIV treatment can live a long and
health life and have effectively no risk of sexually transmitting HIV to
others. Additionally, a person at risk for HIV who is on effective HIV
prevention medication can reduce their risk of getting HIV by 99% when
taking the medication as prescribed.
New York enacted an Antiretroviral (ARV) protected class law in 2005.
The 2011 final enacted state budget carved the drug benefit out of fee-
for-service and into managed care, and removed statutory protections for
ARVs and other drugs, leaving the HIV community with restricted access
and life-threatening delays. Because these protections were rolled back,
insurers now use protocols such as prior authorization in order to mini-
mize prescription drug costs. These protocols have the effect of delay-
ing access to these critically important, time-sensitive drugs which are
particularly harmful for individuals who are currently living with or
seeking to prevent HIV infection.
Restricting access to these life-saving medications undermines the
relationship between a healthcare provider and their patient and puts up
unnecessary roadblocks to prevention and treatment. Specifically, with
HIV treatment, the ability for the patient and medical professional to
rapidly switch antiretroviral medications is key to effectively treating
and stopping the spread of HIV and AIDS. Patients should have open
access to all Single Tablet Regimens (STRs) to fully benefit from
current and future advances in HIV therapy. A large body of evidence
demonstrates that individuals on STR's have higher levels of adherence
to HIV treatment, which improves health outcomes, lowers the risk of
hospitalization and reduces overall healthcare costs. Studies show that
individuals on STRs within the Veterans Affairs health system, had 46%
fewer hospitalizations compared to patients on Multi-tablet Regimens
(MTRs) and were 21% more likely to have undetectable levels of HIV in
the body. Open access to appropriate HIV prevention and treatment medi-
cation for HIV will also support health equity by ensuring that all New
Yorkers have their treatment needs met regardless of their insurance
plan. This bill will ensure that these important anti-retroviral medica-
tions are readily available to patients and not subject to procedural
delays so that patients can start an HIV treatment regimen as soon as
they are diagnosed or exposed to possible infection.
 
PRIOR LEGISLATIVE HISTORY:
2021-22: A.9580 - Referred to Insurance; S.8423 - Referred to Health
 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
None.
 
EFFECTIVE DATE:
This act shall take effect on the one hundred eightieth day after it
shall have become a law.

Statutes affected:
S1001: 273 public health law, 364-j social services law, 3216 insurance law, 3216(i) insurance law, 3221 insurance law, 3221(l) insurance law, 4303 insurance law
S1001A: 3221 insurance law, 3221(l) insurance law, 4303 insurance law