Assembly Bill A901A

2023-2024 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 - 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

Do you support this bill?

Please enter your contact information

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.
Actions

Bill Amendments

co-Sponsors

multi-Sponsors

2023-A901 - Details

See Senate Version of this Bill:
S1267
Current Committee:
Assembly Ways And Means
Law Section:
Insurance Law
Laws Affected:
Amd §§4902 & 4903, Ins L; amd §§4902 & 4903, Pub Health L
Versions Introduced in 2021-2022 Legislative Session:
A9267, S8191

2023-A901 - 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.

2023-A901 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    901
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 11, 2023
                                ___________
 
 Introduced  by M. of A. McDONALD, STECK -- read once and referred 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02501-01-3
 A. 901                              2
              

co-Sponsors

multi-Sponsors

2023-A901A (ACTIVE) - Details

See Senate Version of this Bill:
S1267
Current Committee:
Assembly Ways And Means
Law Section:
Insurance Law
Laws Affected:
Amd §§4902 & 4903, Ins L; amd §§4902 & 4903, Pub Health L
Versions Introduced in 2021-2022 Legislative Session:
A9267, S8191

2023-A901A (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.

2023-A901A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  901--A
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 11, 2023
                                ___________
 
 Introduced  by  M.  of A. McDONALD, STECK, STIRPE, SANTABARBARA, THIELE,
   HEVESI, BURDICK, BEEPHAN, NORRIS, K. BROWN, COLTON, BENDETT,  GUNTHER,
   PAULIN,  SEAWRIGHT,  LEVENBERG, LAVINE, LUNSFORD, ARDILA, COOK, REYES,
   MEEKS, SAYEGH, JACOBSON, SIMPSON, DAVILA,  LUPARDO,  SIMON,  GALLAHAN,
   RAGA  --  Multi-Sponsored  by  --  M.  of  A. EPSTEIN -- read once and
   referred to the Committee on Insurance -- recommitted to the Committee
   on Insurance in accordance with Assembly Rule 3, sec. 2  --  committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee
 
 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 15 and 16 to read as follows:
   (15) 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  AND/OR IS NOT SUPPORTED BY CURRENT EVIDENCE-BASED GUIDE-
 LINES FOR THE MEDICAL CONDITION BEING TREATED;
   (II) REQUIRE AN INSURED TO TRY AND FAIL ON MORE THAN TWO DRUGS  WITHIN
 ONE  THERAPEUTIC  CATEGORY  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  OR  A DURATION OF TREATMENT SUPPORTED BY CURRENT EVIDENCE-
 BASED TREATMENT GUIDELINES APPROPRIATE TO  THE  SPECIFIC  DISEASE  STATE
 BEING TREATED;
   (IV)  BE  IMPOSED  ON  AN  INSURED  IF A THERAPEUTIC EQUIVALENT TO THE
 PRESCRIBED DRUG IS NOT AVAILABLE, OR IF THE HEALTH PLAN  HAS  DOCUMENTA-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02501-04-4
              

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.