Amd §§3221 & 4303, rpld §3216 sub§ (i) ¶36, Ins L; amd §4, Chap of 2022 (as proposed in S.688 & A.807)
Relates to requiring insurance coverage by every large group policy which provides medical, major medical, or comprehensive-type coverage for pre-exposure prophylaxis and post-exposure prophylaxis to prevent HIV infection.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1326
SPONSOR: O'Donnell TITLE OF BILL:
An act to amend the insurance law, in relation to applying coverage
requirements for pre-exposure prophylaxis and post-exposure prophylaxis
to prevent HIV infection to every large group policy which provides
medical, major medical, or comprehensive-type coverage, and repealing
certain provisions of such law relating thereto; and to amend a chapter
of the laws of 2022 amending the insurance law relating to requiring
insurance coverage for pre-exposure prophylaxis and post-exposure
prophylaxis to prevent HIV infection, as proposed in legislative bills
numbers S. 688 and A. 807, in relation to the effectiveness thereof
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill is to make amendments to Chapter 721 of the
Laws of 2022 relating to coverage requirements for pre-exposure prophy-
laxis and post-exposure prophylaxis.
SUMMARY OF PROVISIONS:
Sections 1-3 provides that the requirement for health insurers to
provide coverage for pre-exposure prophylaxis and post-exposure prophy-
laxis to prevent HIV infection shall apply to large group policies.
These sections also clarify that such coverage may be subject to annual
deductibles and coinsurance unless such medication has a rating of 'A'
or '13' in the recommendations of the United States preventive services
task force.
Section 4 provides the effective date.
JUSTIFICATION:
Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are
two important tools for preventing the spread of HIV. According to the
Centers for Disease Control, PrEP has been shown to reduce the risk of
HIV infection in people at high risk of contracting HIV by up to 92%
when taken consistently. PEP regimens are antiretroviral drugs taken to
stop the spread of HIV after a single high-risk event. PEP can be used
to treat health care workers who have been exposed to the blood or body
fluids of HIV-positive patients, as well as people who have been exposed
to HIV through unprotected sex, needle sharing, or 'sexual assault.
Allowing access to PrEP and PEP is an important part of the fight to end
the AIDS epidemic in New York.
Chapter 721 of the Laws of 2022 required health insurers which provide
prescription drugs coverage to provide coverage for the cost of pre-ex-
posure prophylaxis and post-exposure prophylaxis (PrEP) to prevent of
HIV infection. This Chapter amendment provides that such coverage shall
apply to large group policies.
PRIOR LEGISLATIVE HISTORY:
This is a new bill.
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
None noted.
EFFECTIVE DATE:
This act shall take effect immediately and shall apply to all policies
and contracts issued, renewed, modified, altered, or amended on or after
such date,
STATE OF NEW YORK
________________________________________________________________________
1326
2023-2024 Regular Sessions
IN ASSEMBLY
January 17, 2023
___________
Introduced by M. of A. O'DONNELL -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to applying coverage
requirements for pre-exposure prophylaxis and post-exposure prophylax-
is to prevent HIV infection to every large group policy which provides
medical, major medical, or comprehensive-type coverage, and repealing
certain provisions of such law relating thereto; and to amend a chap-
ter of the laws of 2022 amending the insurance law relating to requir-
ing insurance coverage for pre-exposure prophylaxis and post-exposure
prophylaxis to prevent HIV infection, as proposed in legislative bills
numbers S. 688 and A. 807, in relation to the effectiveness thereof
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 21 of subsection (l) of section 3221 of the
2 insurance law, as added by a chapter of the laws of 2022 amending the
3 insurance law relating to requiring insurance coverage for pre-exposure
4 prophylaxis and post-exposure prophylaxis to prevent HIV infection, as
5 proposed in legislative bills numbers S. 688 and A. 807, is amended to
6 read as follows:
7 (21) Every large group policy which provides medical, major medical,
8 or comprehensive-type coverage [for prescription drugs] shall include
9 coverage for the cost of pre-exposure prophylaxis (PrEP) for the
10 prevention of HIV and post-exposure prophylaxis to prevent HIV
11 infection. Such coverage may be subject to annual deductibles and coin-
12 surance as may be deemed appropriate by the superintendent and as are
13 consistent with those established for other benefits within a given
14 policy, unless the pre-exposure prophylaxis (PrEP) or post-exposure
15 prophylaxis has in effect a rating of 'A' or 'B' in the current recom-
16 mendations of the United States preventive services task force.
17 § 2. Subsection (ss) of section 4303 of the insurance law, as added by
18 a chapter of the laws of 2022 amending the insurance law relating to
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD04008-01-3
A. 1326 2
1 requiring insurance coverage for pre-exposure prophylaxis and post-expo-
2 sure prophylaxis to prevent HIV infection, as proposed in legislative
3 bills numbers S. 688 and A. 807, is amended to read as follows:
4 [(ss)](tt) Every large group contract issued by a hospital services
5 corporation or a health services corporation which provides medical,
6 major medical, or comprehensive-type coverage [for prescription drugs]
7 shall include coverage for the cost of pre-exposure prophylaxis (PrEP)
8 for the prevention of HIV and post-exposure prophylaxis to prevent HIV
9 infection. Such coverage may be subject to annual deductibles and coin-
10 surance as may be deemed appropriate by the superintendent and as are
11 consistent with those established for other benefits within a given
12 contract, unless the pre-exposure prophylaxis (PrEP) or post-exposure
13 prophylaxis has in effect a rating of 'A' or 'B' in the current recom-
14 mendations of the United States preventive services task force.
15 § 3. Paragraph 36 of subsection (i) of section 3216 of the insurance
16 law, as added by a chapter of the laws of 2022 amending the insurance
17 law relating to requiring insurance coverage for pre-exposure prophylax-
18 is and post-exposure prophylaxis to prevent HIV infection, as proposed
19 in legislative bills numbers S. 688 and A. 807, is REPEALED.
20 § 4. Section 4 of a chapter of the laws of 2022 amending the insurance
21 law relating to requiring insurance coverage for pre-exposure prophylax-
22 is and post-exposure prophylaxis to prevent HIV infection, as proposed
23 in legislative bills numbers S. 688 and A. 807, is amended to read as
24 follows:
25 § 4. This act shall take effect immediately and shall apply to all
26 policies and contracts issued, renewed, modified, altered, or amended on
27 or after such date.
28 § 5. This act shall take effect immediately and shall apply to all
29 policies and contracts issued, renewed, modified, altered, or amended on
30 or after such date.
