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NY A03789

Bill

Status

Introduced

1/30/2025

Primary Sponsor

David Weprin

Click for details

Origin

Assembly

2025-2026 General Assembly

AI Summary

  • Requires utilization review agents to use evidence-based and peer-reviewed clinical review criteria that account for the needs of typical patient populations and diagnoses when making coverage determinations

  • Shortens the deadline for pre-authorization decisions from three business days to 72 hours for health care services requiring prior approval

  • Mandates that approved pre-authorizations remain valid for the full duration of a prescription, including all authorized refills

  • Extends pre-authorization validity for the entire duration of treatment for a specific condition as requested by the enrollee's health care provider

  • Takes effect 180 days after becoming law

Legislative Description

Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.

Last Action

amend by restoring to original print 3789

2/10/2026

Committee Referrals

Insurance1/7/2026
Rules5/28/2025
Insurance1/30/2025

Full Bill Text

No bill text available