Assembly Actions -
Senate Actions - UPPERCASE
|Jan 17, 2023||
referred to insurance
delivered to assembly
ordered to third reading cal.85
reported and committed to rules
|Jan 11, 2023||
referred to insurance
Senate Bill S1267
2023-2024 Legislative Session
Current Bill Status - In Assembly Committee
- In Committee Assembly
- On Floor Calendar Assembly
- Passed Assembly
- Delivered to Governor
- Signed By Governor
2023-S1267 (ACTIVE) - Details
2023-S1267 (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-S1267 (ACTIVE) - Sponsor Memo
BILL NUMBER: S1267 SPONSOR: BRESLIN TITLE OF BILL: 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 PURPOSE OR GENERAL IDEA OF BILL: The purpose of this bill is to require certain patient protections for plans and utilization review agents to follow when establishing a step therapy protocol. SUMMARY OF PROVISIONS: Section one amends section 4902 of the insurance law by adding two new paragraphs (14) and (15) that require a utilization review agent, when they are establishing a step therapy protocol, to ensure various proto- cols. These include prohibiting a prescription drug that has not been approved by the US FDA from being within a step therapy protocol. In
2023-S1267 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 1267 2023-2024 Regular Sessions I N S E N A T E January 11, 2023 ___________ 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 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02501-01-3 S. 1267 2
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