NY A00901

Prohibits step therapy protocols from requiring prescription drugs not approved by the FDA or unsupported by current evidence-based guidelines for the medical condition being treated.

Limits step therapy to no more than two failed drugs within one therapeutic category before coverage approval, with maximum duration of 30 days or shorter if evidence-based guidelines specify a shorter period.

Prevents step therapy from being imposed if a therapeutic equivalent is unavailable or if the health plan covered the drug for the patient within the past 365 days.

Prohibits newly enrolled patients from repeating step therapy for drugs already completed under a prior plan within the past 365 days, provided documentation is submitted.

Requires health plans to accept written or electronic attestations from healthcare providers as prima facie evidence that a required step therapy drug has failed, and mandates that approved overrides remain honored for the lesser of evidence-based treatment duration or 12 months.