NY A08237

Managed care providers must cover medically necessary prescription drugs and medical supplies, with formularies reviewed and approved by independent pharmacy and therapeutics committees comprised of physicians, pharmacists, and specialists including HIV specialists.

Formularies must include all or substantially all drugs in antidepressant, atypical antipsychotic, antineoplastic, anticonvulsant, immunosuppressant, and anti-retroviral drug classes, with coverage for non-preferred drugs previously prescribed for ongoing conditions.

Prior authorization requests must be processed within two business days, with managed care plans required to cover a minimum 72-hour supply of prescribed drugs while authorization is pending.

Pharmacy and therapeutics committees must meet quarterly, post meeting agendas and materials at least 30 days in advance on state websites, make meeting minutes publicly available within ten business days, and provide opportunity for public testimony before formulary changes.

Department of Health must develop standards for committee composition, establish transparent formulary development processes with public comment periods, create standardized prior authorization forms by April 1, 2013, and report on managed care expansion impacts within 18 months of implementation to new populations or benefits.