NY Pub Health L § 270 (2021)
2021 New York Laws PBH - Public Health Article 2-A - Prescription Drugs Title 1 - Preferred Drug and Clinical Drug Review Programs 270 - Definitions.

§  270.  Definitions.  As  used  in  this  article, unless the context clearly requires otherwise:   1.  "Administrator"  means  an  entity  with  which  the  commissioner contracts  for  the  purpose  of administering elements of the preferred drug program, as established under section two  hundred  seventy-two  of this  article  or  the  clinical  drug  review program established under section two hundred seventy-four of this article.   2. "Board" shall mean the drug utilization review board.   3. "Clinical drug review  program"  means  the  clinical  drug  review program created by section two hundred seventy-four of this article.   4.  "Emergency  condition"  means a medical or behavioral condition as determined by the prescriber or  pharmacists,  the  onset  of  which  is sudden,  that  manifests  itself  by  symptoms  of  sufficient severity, including severe pain,  and  for  which  delay  in  beginning  treatment prescribed by the patient's health care practitioner would result in:  (a)  placing  the  health  or safety of the person afflicted with such condition or other person or persons in serious jeopardy;  (b) serious impairment to such person's bodily functions;  (c) serious dysfunction of any bodily organ or part of such person;  (d) serious disfigurement of such person; or  (e) severe discomfort.   5. "Non preferred drug" means a prescription drug that is included  in the  preferred drug program and is not one of the drugs on the preferred drug list because it is either: (a)  in  a  therapeutic  class  that  is included  in  the  preferred drug program and is not one of the drugs on the preferred  drug  list  in  that  class  or  (b)  manufactured  by  a pharmaceutical manufacturer with whom the commissioner is negotiating or has  negotiated  a  manufacturer  agreement  and is not a preferred drug under a manufacturer agreement.   6. "Panel" means the elderly pharmaceutical insurance  coverage  panel established pursuant to section two hundred forty-four of the elder law.   7.  "Preferred drug" means a prescription drug that is either (a) in a therapeutic class that is included in the preferred drug program and  is one  of  the  drugs  on  the  preferred drug list in that class or (b) a preferred drug under a manufacturer agreement.   8.  "Preferred  drug  program"  means  the  preferred   drug   program established under section two hundred seventy-two of this article.   9.  "Prescription  drug" or "drug" means a drug defined in subdivision seven of section sixty-eight hundred two of the education law, for which a prescription is required under the federal  food,  drug  and  cosmetic act.  Any  drug that does not require a prescription under such act, but which would otherwise meet the criteria under this article for inclusion on the preferred drug list may be added to the preferred drug list under this article;  and,  if  so  included,  shall  be  considered  to  be  a prescription  drug  for purposes of this article; provided that it shall be eligible for reimbursement under a  state  public  health  plan  when ordered  by  a prescriber authorized to prescribe under the state public health plan and the prescription is subject to the applicable provisions of this article and paragraph (a) of subdivision four of  section  three hundred sixty-five-a of the social services law.   10.  "Prior authorization" means a process requiring the prescriber or the dispenser to verify with the applicable state public health plan  or its  authorized  agent that the drug is appropriate for the needs of the specific patient.   11. "State public health plan" means the  medical  assistance  program established  by  title eleven of article five of the social services law (referred to in this article as "Medicaid"), the elderly  pharmaceutical insurance  coverage program established by title three of article two of  the elder law (referred to in this article as "EPIC"),  and  the  family health  plus  program established by section three hundred sixty-nine-ee of the social services law to the extent that section provides that  the program shall be subject to this article.   12.   "Supplemental   rebate"   means   a  supplemental  rebate  under subdivision eleven of section two hundred seventy-two of this article.   13. "Therapeutic class" means  a  group  of  prescription  drugs  that produce  a particular intended clinical outcome and are grouped together as a therapeutic class by the pharmacy and therapeutics committee.   14.  "Manufacturer  agreement"  means   an   agreement   between   the commissioner  and  a  pharmaceutical manufacturer under paragraph (b) of subdivision eleven of section two hundred seventy-two of this article.