NY A08501

Repeals paragraph 14 of Insurance Law section 4902(a) and subsection (e-1) of Insurance Law section 4903, along with corresponding provisions in Public Health Law section 4902 and 4903, that were added by 2023 legislation on step therapy determinations.

Amends notice requirements for adverse determinations to include: clinical review criteria, appeal instructions, availability of clinical review criteria upon request, additional information needed for appeal, and for step therapy protocol overrides specifically, information on clinical review criteria and alternative prescription drugs available under the protocol.

Allows utilization review agents to provide adverse determination notices for step therapy protocol overrides electronically, including by email or through health plan member and provider portals, with linked website information meeting the alternative drug disclosure requirements.

Applies the same amended notice requirements to both Insurance Law and Public Health Law provisions governing utilization review agents' adverse determinations.

Takes effect on the same date as the 2023 legislation that this bill amends and partially repeals (referenced as S. 2677-A and A. 463-A).