senate Bill S8191

2021-2022 Legislative Session

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

download bill text pdf

Sponsored By

Current Bill Status - Passed Senate


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

view actions (6)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
May 24, 2022 referred to insurance
delivered to assembly
passed senate
May 23, 2022 ordered to third reading cal.1440
committee discharged and committed to rules
Feb 01, 2022 referred to insurance

Co-Sponsors

S8191 (ACTIVE) - Details

See Assembly Version of this Bill:
A9267
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§4902 & 4903, Ins L; amd §§4902 & 4903, Pub Health L

S8191 (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.

S8191 (ACTIVE) - Sponsor Memo

S8191 (ACTIVE) - Bill Text download pdf

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8191
 
                             I N  S E N A T E
 
                             February 1, 2022
                                ___________
 
 Introduced  by  Sen. BRESLIN -- read twice and ordered printed, and when
   printed to be committed to the Committee 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
 S. 8191                             2

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