NY A10249

Establishes a "qualified prescription drug system" for Medicaid managed care providers to manage prescription drug coverage through preferred and non-preferred drug lists, with prior authorization requirements for non-preferred drugs.

Requires 24/7 call centers with qualified healthcare professionals to handle prior authorization requests, with automatic approval if decisions are not made within 24 hours due to system failure, or 72-hour emergency supply approval for other delays.

Permits prescribers to obtain prior authorization for non-preferred drugs if the patient has tried preferred drugs without success, experienced unacceptable side effects, is stabilized on a non-preferred drug, or has other clinical indications identified by the commissioner.

Exempts atypical anti-psychotics, anti-depressants, anti-retrovirals for HIV/AIDS, anti-rejection transplant drugs, and other commissioner-approved drugs for mental illness or HIV/AIDS from prior authorization requirements.

Allows participants to fill mail order prescriptions at any retail pharmacy in the network offering comparable pricing, and repeals prior law (Chapter 56 of 2012, Section 55 Part D) regarding prescription drug payments.