On Dec. 21, 2024, NY LEG reported governor approved SB1267(AB0901) as Chap 641.
Document dated Dec. 21, 2024, received from NY LEG Dec. 24, summarized Dec. 30.
In Feb. 2025, NY LEG issued bill re health care plan step therapy protocol, #245788.
On Jun. 5, NY LEG passed bill on step therapy protocol requirements.
NY LEG passed bill SB 1267 (AB 00901) to require a utilization review agent to follow certain rules when establishing a step therapy protocol, require patient protections.
Amends Insurance LawNY INS 28-49-1-4902, utilization review program standards.
Bill Provisions
Step therapy protocols established by a utilization review agent must require use of FDA-approved prescription drug, and/or be supported by current clinical guidelines.
The legislation also provides that an insured need only try and fail on two drugs within one therapeutic category before providing coverage of the prescribed drug.
Insured to try a step-therapy required drug for 30 days or less or a duration of treatment supported by current evidence based for medical condition being treated.
Only imposed on insured if a therapeutic equivalent to the prescribed drug is available.
Cannot require newly insured to repeat therapy for prescribed drug where that insured already completed therapy for that drug under a prior plan, subject to disclosures.
Legislative History
On Jan. 11, 2023, bill introduced in Senate; on Jan. 17, 2023, bill passed in Senate.
On Jan. 3, 2024, bill died in Assembly; on Jan. 30, 2024, bill passed Senate again.
On May 15, 2024, bill was recalled from the Assembly and returned to the Senate.
On May 21, 2024, bill passed in the Senate and was returned to the Assembly.
On Jun. 3, 2024, bill substituted for A 901; on Jun. 5, 2024, bill passed Assembly.
Effectiveness
Act takes effect on the one hundred twentieth day after it shall have become a law.
Dec. 2024 NY LEG Governor Approval
On Dec. 21, 2024, NY LEG reported governor approved SB1267(AB0901) as Chap 641.
Document dated Dec. 21, 2024, received from NY LEG Dec. 24, summarized Dec. 30.
In Feb. 2025, NY LEG issued bill re health care plan step therapy protocol, #245788.
Regulators
NY LEG
Entity Types
Ins
Reference
Ch. 641, 12/21/2024; Bill, S01267, A00901, 6/5/2024; Citation: NY INS 28-49-1-4902;
