New York S 5534: Prohibits Medicaid from requiring prior authorization for certain HIV medications

Bill Text

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S05534 Summary:

BILL NOS05534 

&nbsp

SAME ASSAME AS A00026

&nbsp

SPONSORHOYLMAN-SIGAL

&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 S05534 Actions:

BILL NOS05534 

&nbsp

02/24/2025REFERRED TO HEALTH

05/20/20251ST REPORT CAL.1264

05/21/20252ND REPORT CAL.

05/22/2025ADVANCED TO THIRD READING 

06/12/2025SUBSTITUTED BY A26

&nbspA00026 AMEND= Rosenthal

&nbsp01/08/2025referred to health

&nbsp04/08/2025reported referred to ways and means

&nbsp05/20/2025reported referred to rules

&nbsp05/27/2025reported 

&nbsp05/27/2025rules report cal.256

&nbsp05/27/2025ordered to third reading rules cal.256

&nbsp06/05/2025passed assembly

&nbsp06/05/2025delivered to senate

&nbsp06/05/2025REFERRED TO RULES

&nbsp06/12/2025SUBSTITUTED FOR S5534

&nbsp06/12/20253RD READING CAL.1264

&nbsp06/12/2025PASSED SENATE

&nbsp06/12/2025RETURNED TO ASSEMBLY

&nbsp12/08/2025delivered to governor

&nbsp12/19/2025vetoed memo.116

&nbsp12/19/2025tabled

Go to topS05534 Committee&nbspVotes:

Go to topS05534 Floor&nbspVotes:

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

Go to topS05534 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 5534

 2025-2026 Regular Sessions

 IN SENATE

 February 24, 2025
 ___________

 Introduced by Sen. HOYLMAN-SIGAL -- 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

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

 S. 5534 2

 1 accordance with section two hundred seventy-three of the public health
 2 law; provided further that the commissioner of health shall not require
 3 prior authorization of antiretroviral prescription drugs for the treat-
 4 ment or prevention of the human immunodeficiency virus (HIV) or acquired
 5 immunodeficiency syndrome (AIDS); medical assistance shall not include
 6 any drug provided on other than