NY A01384

Health care plans and utilization review agents must annually report to the Department of Financial Services and Department of Health step therapy override request data organized by drug name, category, and class, including number of requests, provider types, denial reasons, approvals, and internal appeal reversals.

Health care plans and utilization review agents must publicly disclose non-confidential step therapy override information on a website or web-based tool using the same data categories as annual reports.

Insurers, health service corporations, hospital service corporations, and health maintenance organizations must disclose step therapy protocols, override determinations, appeal procedures, and clinical review criteria on their websites and in written or electronic form upon request.

Insurers and health maintenance organizations must update their websites before implementing any new or amended step therapy requirements, restrictions, or clinical review criteria, and must provide affected insureds and health care professionals with written notice at least 60 days before implementation.

Paragraph 10 of subsection (b) of sections 3217-a and 4324 of the insurance law and paragraph (j) of subdivision 2 of section 4408 of the public health law are repealed.