New York S 10458: Prohibits Medicaid from requiring prior authorization for certain HIV medications

Bill Text

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S10458 Summary:

BILL NOS10458 

&nbsp

SAME ASSAME AS A09547

&nbsp

SPONSORBOTTCHER

&nbsp

COSPNSRJACKSON

&nbsp

MLTSPNSR

&nbsp

Amd §§365-a & 364-j, Soc Serv L; amd §273, Pub Health L

&nbsp

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).

Go to top S10458 Actions:

BILL NOS10458 

&nbsp

05/15/2026REFERRED TO HEALTH

Go to topS10458 Committee&nbspVotes:

Go to topS10458 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topS10458 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 10458

 IN SENATE

 May 15, 2026
 ___________

 Introduced by Sens. BOTTCHER, JACKSON -- 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
 25 accordance with section two hundred seventy-three of the public health
 26 law; provided further that the commissioner of health shall not require
 27 prior authorization of antiretroviral prescription drugs for the treat-

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD00020-01-5

 S. 10458 2

 1 ment or prevention of the human immunodeficiency virus (HIV) or acquired
 2 immunodeficiency syndrome (AIDS); medical assistance shall not include
 3 any drug provided on other than an in-patient basis for which a recipi-
 4 ent is charged or a claim is made in the case of a prescription drug, in
 5 excess of the maximum reimbursable amounts to be established by depart-
 6 ment regulations in accordance with standards established by the secre-
 7 tary of the United States department of health and human services, or,
 8 in the case of a drug not requiring a prescription, in excess of the
 9 maximum reimbursable amount established by the commissioner of health
 10 pursuant to paragraph (a) of subdivision four of this section;
 11 § 2. Section 364-j of the social services law is amended by adding a
 12 new subdivision 26-d to read as follows:
 13 26-d. Managed care providers shall not require prior authorization for
 14 any antiretroviral prescription drugs for the treatment or prevent