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NY S01267
Bill
Status
12/21/2024
Primary Sponsor
Neil Breslin
Click for details
AI Summary
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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
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Limits step therapy requirements to no more than two failed drugs within one therapeutic category before covering the prescribed drug
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Restricts step therapy-required drugs to a maximum of 30 days or the duration supported by current evidence-based treatment guidelines, whichever is less
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Requires step therapy protocols to accept written or electronic attestations from health care professionals as prima facie evidence that a required drug has failed
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Specifies that step therapy protocol overrides remain valid for the lesser of either the evidence-based treatment duration or twelve months following approval, and mandates override status if utilization review agents fail to comply with these requirements
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
APPROVAL MEMO.72
12/21/2024