NY A09206

Health care plans and utilization review agents must annually report to the Department of Financial Services and Department of Health information about step therapy override requests, including the number received, types of providers submitting them, approval and denial rates, and internal appeal reversals, organized by drug name and category.

Health care plans and utilization review agents must disclose non-confidential step therapy override information on publicly accessible websites or web-based tools, organized by individual drug name and drug category and class.

Insurers, health service corporations, hospital service corporations, medical indemnity corporations, and health maintenance organizations must disclose step therapy protocols, override determinations, appeals procedures, and related clinical review criteria on their websites and provide this information upon request to insureds and health care professionals.

Insurers and health plans must update their websites with any new or amended step therapy requirements or restrictions before implementation and must provide written notice to affected insureds and health care professionals at least 60 days before such changes take effect.

Repeals existing paragraph 10 of section 3217-a of the insurance law and paragraph 10 of section 4324 of the insurance law, and repeals paragraph (j) of subdivision 2 of section 4408 of the public health law regarding step therapy disclosure requirements.