NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A8035
SPONSOR: Steck TITLE OF BILL:
An act to amend the insurance law and the public health law, in relation
to electronic notification when prior authorization is required to fill
a prescription
PURPOSE:
To require health insurers to create an opt-in program by which insureds
are notified electronically 30-days in advance should their medication
require prior authorization at their next fill-date
SUMMARY OF PROVISIONS:
Section 1. Paragraphs 13 and 14 of subsection (b) of section 3217-a of
the insurance law, as added by section 2 of part H of chapter 60 of the
laws of 2014, are amended and a new paragraph 15 is added to read as
follows:
(15) WHERE APPLICABLE, ALLOW AN INSURED TO REQUEST AN ELECTRONIC
NOTIFICATION WITHIN THIRTY DAYS WHEN PRIOR AUTHORIZATION IS REQUIRED TO
FILL A PRESCRIPTION.ct.
§ 2. Paragraphs 13 and 14 of subsection (b) of section 4324 of the
insurance law, as added by section 9 of part H of chapter 60 of the laws
of 2014, are amended and a new paragraph 15 is added to read as follows:
(15) WHERE APPLICABLE, ALLOW AN INSURED TO REQUEST AN ELECTRONIC
NOTIFICATION WITHIN THIRTY DAYS WHEN PRIOR AUTHORIZATION IS REQUIRED TO
FILL A PRESCRIPTION.ct.
§ 3. Paragraphs (m) and (n) of subdivision 2 of section 4408 of the
public health law, as added by section 19 of part H of chapter 60 of the
laws of 2014, are amended and a new paragraph (o) is added to read as
follows:
(O) WHERE APPLICABLE, ALLOW AN INSURED TO REQUEST AN ELECTRONIC NOTIFI-
CATION WITHIN THIRTY DAYS WHEN PRIOR AUTHORIZATION IS REQUIRED TO FILL A
PRESCRIPTION.ct.
§ 4. Effective date
JUSTIFICATION:
With longer wait times for both healthcare providers and pharmacies,
many patients find put they cannot fill their prescription until a prior
authorization is completed. This can be a lengthy process, especially if
your healthcare provider serves a large number of patients. If patients
are notified 30-days prior that a prior authorization is required at
their next prescription fill date would allow more time for prescribers
to complete this process, as well as allow patients to obtain their
medication without unnecessary delay.
LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS:
TBD
EFFECTIVE DATE:
Effective immediately.
STATE OF NEW YORK
________________________________________________________________________
8035
2023-2024 Regular Sessions
IN ASSEMBLY
September 13, 2023
___________
Introduced by M. of A. STECK -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law and the public health law, in relation
to electronic notification when prior authorization is required to
fill a prescription
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraphs 13 and 14 of subsection (b) of section 3217-a of
2 the insurance law, as added by section 2 of part H of chapter 60 of the
3 laws of 2014, are amended and a new paragraph 15 is added to read as
4 follows:
5 (13) disclose whether a health care provider scheduled to provide a
6 health care service is an in-network provider; [and]
7 (14) with respect to out-of-network coverage, disclose the approximate
8 dollar amount that the insurer will pay for a specific out-of-network
9 health care service. The insurer shall also inform the insured through
10 such disclosure that such approximation is not binding on the insurer
11 and that the approximate dollar amount that the insurer will pay for a
12 specific out-of-network health care service may change[.]; and
13 (15) where applicable, allow an insured to request an electronic
14 notification within thirty days when prior authorization is required to
15 fill a prescription.
16 § 2. Paragraphs 13 and 14 of subsection (b) of section 4324 of the
17 insurance law, as added by section 9 of part H of chapter 60 of the laws
18 of 2014, are amended and a new paragraph 15 is added to read as follows:
19 (13) disclose whether a health care provider scheduled to provide a
20 health care service is an in-network provider; [and]
21 (14) with respect to out-of-network coverage, disclose the approximate
22 dollar amount that the corporation will pay for a specific out-of-net-
23 work health care service. The corporation shall also inform the insured
24 through such disclosure that such approximation is not binding on the
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13192-01-3
A. 8035 2
1 corporation and that the approximate dollar amount that the corporation
2 will pay for a specific out-of-network health care service may
3 change[.]; and
4 (15) where applicable, allow an insured to request an electronic
5 notification within thirty days when prior authorization is required to
6 fill a prescription.
7 § 3. Paragraphs (m) and (n) of subdivision 2 of section 4408 of the
8 public health law, as added by section 19 of part H of chapter 60 of the
9 laws of 2014, are amended and a new paragraph (o) is added to read as
10 follows:
11 (m) disclose whether a health care provider scheduled to provide a
12 health care service is an in-network provider; [and]
13 (n) with respect to out-of-network coverage, disclose the approximate
14 dollar amount that the health maintenance organization will pay for a
15 specific out-of-network health care service. The health maintenance
16 organization shall also inform an enrollee through such disclosure that
17 such approximation is not binding on the health maintenance organization
18 and that the approximate dollar amount that the health maintenance
19 organization will pay for a specific out-of-network health care service
20 may change[.]; and
21 (o) where applicable, allow an insured to request an electronic
22 notification within thirty days when prior authorization is required to
23 fill a prescription.
24 § 4. This act shall take effect immediately.
