Bill > S04689

This bill requires health care plans and utilization review agents to provide enhanced transparency around step therapy override requests and determinations. Specifically, these organizations must annually report detailed information to state departments about step therapy override requests, including the number of requests received, the types of healthcare providers submitting requests, the number of requests initially denied or approved, and the number of requests reversed on internal appeal. The bill mandates that this information be disclosed publicly on a website or web-based tool, with data organized by individual drug name, category, and class. Additionally, insurers must update their websites when implementing new or amended step therapy protocols and provide at least 60 days' written notice to potentially impacted insureds or healthcare professionals before making such changes. Step therapy is a process where patients must first try a less expensive medication before an insurer will cover a more costly prescribed medication. The bill aims to increase transparency and provide patients and healthcare providers with more insight into how step therapy decisions are made, potentially helping them better navigate insurance coverage requirements.

Business and Industry

https://www.nysenate.gov/legislation/bills/2025/S4689