Steck, Gunther, Stirpe, Bendett, Brown K, Paulin, Lunsford
MLTSPNSR
Amd §4902, Ins L; amd §4902, Pub Health L
Ensures that step therapy shall not apply to medically necessary prescription drugs in the dermatologic, hematology, ophthalmologic, rheumatic, gastrointestinal, neurology, and oncology therapeutic classes, including non-formulary drugs.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A582
SPONSOR: McDonald TITLE OF BILL:
An act to amend the insurance law and the public health law, in relation
to protecting certain therapeutic classes from step therapy
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill is to prevent plans from implementing step
therapy policies for certain progressive diseases.
SUMMARY OF PROVISIONS:
Section one amends section 4902 of the insurance law to prohibit a
utilization review agent from applying a step therapy protocol to
medically necessary prescription drugs in dermatologic, hematology,
ophthalmologic, rheumatic, gastrointestinal, neurology, and oncology
therapeutic classes, including non-formulary drugs.
Section two amends section 4902 of the public health law to reflect the
same requirement as section one.
Section three requires that this act shall take effect immediately.
JUSTIFICATION:
Step therapy interferes with the prescriber-patient relationship and
delays access to necessary care, which can negatively impact patients'
health. This is especially true for those with progressive diseases who
require timely access to their prescribed treatment to avoid advancing
the condition and potentially causing irreversible harm.
PRIOR LEGISLATIVE HISTORY:
2021-2022: A.9250
FISCAL IMPLICATIONS:
None
EFFECTIVE DATE:
This act shall take effect immediately.
STATE OF NEW YORK
________________________________________________________________________
582
2023-2024 Regular Sessions
IN ASSEMBLY
January 9, 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 protecting certain therapeutic classes from step therapy
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subsection (a) of section 4902 of the insurance law is
2 amended by adding a new paragraph 14 to read as follows:
3 (14) When establishing a step therapy protocol, a utilization review
4 agent shall ensure that such protocol shall not apply to medically
5 necessary prescription drugs in the dermatologic, hematology, ophthalmo-
6 logic, rheumatic, gastrointestinal, neurology, and oncology therapeutic
7 classes, including non-formulary drugs.
8 § 2. Section 4902 of the public health law is amended by adding a new
9 subdivision 5 to read as follows:
10 5. When establishing a step therapy protocol, a utilization review
11 agent shall ensure that such protocol shall not apply to medically
12 necessary prescription drugs in the dermatologic, hematology, ophthalmo-
13 logic, rheumatic, gastrointestinal, neurology, and oncology therapeutic
14 classes, including non-formulary drugs.
15 § 3. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD02499-01-3
