New law limits methods health insurers and PBMs can use to delay and discourage access to medically necessary treatments.
ALBANY, NY / ACCESSWIRE / December 23, 2024 / New York Gov. Kathy Hochul signed legislation on December 21 that puts new controls on the state's health insurers and pharmacy benefit managers (PBMs). The new law limits ways step therapy can be used to delay and discourage insured New Yorkers' access to their medically necessary prescription drugs.
Health insurers and PBMs use step-therapy to require patients to try and "fail first" on alternative treatments before they can access the treatment their health care provider originally prescribed.
"The New York Step Therapy Alliance has worked tirelessly over the last three years to urge legislators to pass these protections. Without reasonable guardrails, step-therapy can cause significant delays in insured consumers' access to medically necessary treatments, increase costs for consumers and insurers, and lead to treatment discontinuation," said Ashira Vantrees, Director of Legal Strategy and Advocacy at Aimed Alliance, a not-for-profit health policy organization.
Senate Bill 1267A/Assembly Bill A901A will take effect on January 1, 2026. The law prohibits the following step therapy protocols:
Requiring the patient to try and fail on:
Medications not FDA-approved or recommended in evidence-based guidelines for the patient's medical condition;
More than two medications;
Requiring the use of a step therapy drug for more than 30 days or a timeline based on current medical guidelines; and
Imposing repeat step therapy after approving a prescribed drug unless 365 days have passed since the approval or an evidence-based safety concern exists.
The law requires health insurers and PBMs to accept health care providers' attestations as evidence that their patients have tried and failed on required drugs.
In the Senate, the bill was sponsored by Sens. Neil Breslin; Joseph Addabbo, Jr.; Nathalia Fernandez; Rachel May; and James Skoufis.
The bill's primary Assembly sponsor was Assemblymember John T. McDonald III.
"These commonsense guardrails will make a world of difference for patients," Ms. Vantrees said.
"Governor Hochul and the New York Legislature are national leaders in protecting patients from harmful benefit utilization policies. This new law sets an example for the type of protections other states should enact in 2025."
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About Aimed Alliance
Aimed Alliance is a 501 (c)(3) not-for-profit health policy organization that protects and enhances the rights of health care consumers and providers. For more information, visit aimedalliance.org.
Media Contact
Ashira Vantrees, Esq.
Director of Legal Strategy and Advocacy
policy@aimedalliance.org
SOURCE: Aimed Alliance
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