BILL NUMBER: S5534
SPONSOR: HOYLMAN-SIGAL
 
TITLE OF BILL:
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
 
PURPOSE:
This legislation will ensure Medicaid patients are not required to
obtain prior authorization for medications to treat and prevent HIV.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section one amends subdivision 2 of section 365-a of the social services
law.
Section two adds a new subdivision 26-d to section 364-j of the social
services law. Section three adds a new subdivision 11 to section 273 of
the public health law Section four establishes the effective date,
 
JUSTIFICATION:
New York State's "Ending the Epidemic" plan identified three key points
to ending the HIV epidemic, including identifying undiagnosed people
living with HIV, helping people who are HIV positive get treatment, and
facilitating access to medications that protect high -risk persons from
contracting HIV. The plan highlighted the importance of providing
better, more immediate access to antiretroviral drugs to combat the
epidemic, but prior authorization requirements have tong contributed to
treatment delays and disruptions.
In 2024, New York State passed into law a measure (Chapter 152 of 2024)
to prohibit private insurers from restricting or delaying access to
antiretroviral medications through prior authorization requirements,
though the law did not cover Medicaid plans. Antiretroviral drugs are
critical to preventing transmission and controlling growth of the virus,
but it is important that patients can access them quickly when
prescribed. Given the complexities of HIV/AIDS, doctors may need to try
various treatments and drug combinations, and delays can have harmful
consequences.
This legislation would build upon the 2024 law by also prohibiting the
use of prior authorization for antiretroviral drugs used in connection
to HIV/AIDS for patients on Medicaid, ensuring they can access lifesav-
ing treatments without delay.
 
LEGISLATIVE HISTORY:
2023-24: A.10716 - Referred to Health
 
FISCAL IMPLICATIONS:
Undetermined.
 
EFFECTIVE DATE:
This act shall take effect on the one hundred eightieth day after it
shall have become law.

Statutes affected:
S5534: 365-a social services law, 365-a(2) social services law, 364-j social services law, 273 public health law