Loading chat...
NY A09267
Bill
Status
2/9/2022
Primary Sponsor
John McDonald
Click for details
AI Summary
-
Prohibits step therapy protocols from requiring unapproved prescription drugs, requiring patients to fail on more than one drug before coverage, or requiring step therapy drugs for longer than 30 days.
-
Prevents step therapy protocols from being imposed on patients who took the prescribed drug within the past 365 days or on newly enrolled patients who already completed step therapy for that drug under a prior plan.
-
Bars step therapy protocols when a drug was previously approved for a specific medical condition and the plan later implements a formulary change affecting that drug's coverage status.
-
Requires utilization review agents to accept attestations from health care professionals stating a required step therapy drug has failed as prima facie evidence of failure.
-
Requires step therapy protocol override approvals to remain honored for the longer of 12 months or until plan renewal, and makes failure to comply with these requirements grounds for granting a step therapy override.
Legislative Description
Requires a utilization review agent to follow certain rules when establishing a step therapy protocol; requires that the protocol accepts any attestation submitted by the insured's health care professional stating that a required drug has failed as prima facie evidence that the required drug has failed.
Last Action
referred to insurance
2/9/2022