Bill > A00443

This bill modifies regulations related to step therapy protocols in health care plans, primarily focusing on limitations and patient protections. Step therapy is a process where insurers require patients to try less expensive medications before approving coverage for a prescribed drug. The bill restricts utilization review agents from implementing overly restrictive step therapy protocols by prohibiting requirements such as: using drugs not FDA-approved or not supported by current treatment guidelines, forcing patients to try and fail more than two drugs, requiring drug trials longer than 30 days, or mandating a new step therapy protocol for patients who have already completed one under a previous health care plan. The bill also ensures that health care professionals' attestations about a drug's failure will be accepted as evidence, and it requires health care plans to authorize immediate coverage when a step therapy protocol is determined to be inappropriate. A key provision changes the effective date of the original legislation (S.1267-A and A.901-A) from 120 days after becoming law to January 1, 2026, which will apply to all health care policies issued, renewed, modified, altered, or amended on or after that date. The modifications aim to provide more flexibility and patient-centered care in prescription drug coverage.

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https://www.nysenate.gov/legislation/bills/2025/A443