Assembly Bill A9267

2021-2022 Legislative Session

Requires a utilization review agent to follow certain rules when establishing a step therapy protocol

download bill text pdf

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Archive: Last Bill Status - In Assembly Committee


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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2021-A9267 (ACTIVE) - Details

See Senate Version of this Bill:
S8191
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§4902 & 4903, Ins L; amd §§4902 & 4903, Pub Health L
Versions Introduced in 2023-2024 Legislative Session:
A901, S1267

2021-A9267 (ACTIVE) - Summary

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.

2021-A9267 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9267
 
                           I N  A S S E M B L Y
 
                             February 9, 2022
                                ___________
 
 Introduced by M. of A. McDONALD -- read once and referred to the Commit-
   tee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to  requiring  a utilization review agent to follow certain rules when
   establishing a step therapy protocol
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.  Subsection  (a)  of  section 4902 of the insurance law is
 amended by adding two new paragraphs 14 and 15 to read as follows:
   (14) WHEN ESTABLISHING A STEP THERAPY PROTOCOL, A  UTILIZATION  REVIEW
 AGENT SHALL ENSURE THAT THE PROTOCOL CANNOT:
   (I)  REQUIRE  A  PRESCRIPTION  DRUG  THAT HAS NOT BEEN APPROVED BY THE
 UNITED STATES FOOD AND DRUG ADMINISTRATION  FOR  THE  MEDICAL  CONDITION
 BEING TREATED;
   (II)  REQUIRE  AN INSURED TO TRY AND FAIL ON MORE THAN ONE DRUG BEFORE
 PROVIDING COVERAGE TO THE INSURED FOR THE PRESCRIBED DRUG;
   (III) REQUIRE THE USE OF A STEP THERAPY-REQUIRED DRUG FOR LONGER  THAN
 THIRTY DAYS;
   (IV)  BE IMPOSED ON AN INSURED IF THE INSURED HAS TAKEN THE PRESCRIBED
 DRUG COVERED BY THE PLAN WITHIN THE PAST THREE HUNDRED SIXTY-FIVE DAYS;
   (V) REQUIRE A NEWLY ENROLLED INSURED TO  REPEAT  STEP  THERAPY  FOR  A
 PRESCRIBED  DRUG  WHERE  THAT INSURED ALREADY COMPLETED STEP THERAPY FOR
 THAT DRUG UNDER A PRIOR PLAN; AND
   (VI) BE IMPOSED ON AN INSURED FOR A PRESCRIBED DRUG THAT WAS PREVIOUS-
 LY APPROVED FOR COVERAGE BY A PLAN  FOR  A  SPECIFIC  MEDICAL  CONDITION
 AFTER  THE INSURED'S PLAN IMPLEMENTS A FORMULARY CHANGE THAT IMPACTS THE
 FORMULARY STATUS OF THE PRESCRIBED DRUG.
   (15) WHEN ESTABLISHING A STEP THERAPY PROTOCOL, A  UTILIZATION  REVIEW
 AGENT  SHALL  ENSURE THAT THE PROTOCOL ACCEPTS ANY ATTESTATION SUBMITTED
 BY THE INSURED'S HEALTH CARE PROFESSIONAL AS  DEFINED  IN  SECTION  FOUR
 THOUSAND  NINE  HUNDRED  OF  THIS TITLE STATING THAT A REQUIRED DRUG HAS
 FAILED AS PRIMA FACIE EVIDENCE THAT THE REQUIRED DRUG HAS FAILED.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD14433-01-2
 A. 9267                             2
              

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