Bill > S06164

This bill requires Medicaid managed care and Child Health Plus (Children's Health Insurance Program) plans to adopt a standardized prescription drug approval process called a "qualified prescription drug system" that includes several key protections for patients and providers. The system mandates a 24/7 telephone support center for prior authorization requests, establishes clear criteria for approving non-preferred drugs, and includes a "prescriber prevails" provision that allows healthcare providers to ultimately determine the most appropriate medication for their patients. Under this system, if a non-preferred drug is deemed medically necessary - such as when a preferred drug has failed, caused side effects, or would disrupt a patient's current treatment - the prescriber can obtain authorization. The bill also waives prior authorization requirements for certain critical medication classes like anti-psychotics, anti-depressants, HIV/AIDS treatments, and anti-rejection drugs. Additionally, in emergency situations, a 72-hour medication supply must be immediately authorized, and if a prior authorization request is not processed within 24 hours, it is automatically approved. This legislation aims to streamline prescription drug access while maintaining cost-effectiveness and clinical appropriateness in Medicaid and Child Health Plus programs.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/S6164