Prohibits insurers from restricting or imposing delays in the distribution of antiretroviral prescription drugs prescribed to a person for the treatment or prevention of the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS).
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1619A
SPONSOR: Rosenthal L 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
feefor-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 minimize prescription drug costs. These protocols have the
effect of delaying 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-ta-
blet Regimens (MTRs) and were 21% more likely to have undetectable
levels of HIV in the body. Open access to appropriate HIV prevention and
treatment medication 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-retrovi-
ral medications 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.
STATE OF NEW YORK
________________________________________________________________________
1619--A
2023-2024 Regular Sessions
IN ASSEMBLY
January 17, 2023
___________
Introduced by M. of A. L. ROSENTHAL, SIMON, BRONSON -- read once and
referred to the Committee on Insurance -- recommitted to the Committee
on Insurance in accordance with Assembly Rule 3, sec. 2 -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the insurance law, in relation to prohibiting insurers
from restricting or imposing delays in the distribution of antiretro-
viral prescription drugs to certain persons
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subsection (i) of section 3216 of the insurance law is
2 amended by adding a new paragraph 39 to read as follows:
3 (39) No policy that provides coverage for antiretroviral prescription
4 drugs prescribed for the treatment or prevention of the human immunode-
5 ficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) shall
6 subject such drugs to prior authorization.
7 § 2. Subsection (l) of section 3221 of the insurance law is amended by
8 adding a new paragraph 22 to read as follows:
9 (22) Every group or blanket policy delivered or issued for delivery in
10 this state that provides coverage for antiretroviral prescription drugs
11 for the treatment or prevention of the human immunodeficiency virus
12 (HIV) or acquired immunodeficiency syndrome (AIDS) shall not subject
13 such drug to a prior authorization requirement.
14 § 3. Section 4303 of the insurance law is amended by adding a new
15 subsection (vv) to read as follows:
16 (vv) Any contract issued by a medical expense indemnity corporation, a
17 hospital service corporation or a health services corporation that
18 provides coverage for antiretroviral prescription drugs for the treat-
19 ment or prevention of the human immunodeficiency virus (HIV) or acquired
20 immunodeficiency syndrome (AIDS) shall not subject such drug to a prior
21 authorization requirement.
22 § 4. This act shall take effect on the one hundred eightieth day after
23 it shall have become a law.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD04099-02-4
