All Roll Calls
Yes: 206 • No: 1
New YorkA 4432025-2026 Regular SessionHouseWALLET
Relates to step therapy protocol
Sponsored By: John T. McDonald III (Democratic)
Signed by Governor
INSURANCERULES
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 2 benefits, 0 costs, 0 mixed.
Easier drug coverage exceptions for patients
These New York protections apply to health policies issued, renewed, or changed beginning January 1, 2026. Review agents must accept the prescribing professional's written or electronic statement that a required drug failed. Missing a legal deadline for step therapy review or an exception decision automatically overrides the required steps. Breaking step therapy rules also provides grounds for an override, absent fraud. Once an override is granted, the plan must authorize coverage for the prescribed drug immediately. The override lasts until the shorter of the guideline-supported treatment period or 12 months after approval or coverage renewal.
Fewer required drug trials for patients
These New York protections apply to health policies issued, renewed, or changed beginning January 1, 2026. Step therapy means requiring patients to try other drugs before covering the prescribed drug. Plans cannot require drugs without FDA approval for the condition or without support from current treatment guidelines. They cannot require more than two failed drugs for the same condition, or trials beyond 30 days unless guidelines support longer treatment. Plans cannot require step therapy when no equivalent treatment exists or when they covered the drug within the past 365 days. New enrollees avoid repeating steps by submitting proof they completed them under a prior plan within the past 365 days. After changes to drug lists or coverage rules, an approved drug stays protected from new steps until its override expires. An exception requires both a current, evidence-based safety concern and a different treatment option.
Sponsors & Cosponsors
Sponsor
John T. McDonald III
Democratic • House
Cosponsors
MaryJane Shimsky
Democratic • House
Roll Call Votes
Senate vote • 2/11/2025
FLOOR Vote
Yes: 60 • No: 1
House vote • 2/4/2025
Assembly floor vote
Yes: 146 • No: 0
Actions Timeline
SIGNED CHAP.20
2/14/2025HouseDELIVERED TO GOVERNOR
2/12/2025HouseRETURNED TO ASSEMBLY
2/11/2025SenatePASSED SENATE
2/11/2025Senate3RD READING CAL.159
2/11/2025SenateSUBSTITUTED FOR S2676
2/11/2025SenateREFERRED TO RULES
2/4/2025SenateDELIVERED TO SENATE
2/4/2025HousePASSED ASSEMBLY
2/4/2025HouseORDERED TO THIRD READING RULES CAL.73
1/28/2025HouseRULES REPORT CAL.73
1/28/2025HouseREPORTED
1/28/2025HouseREPORTED REFERRED TO RULES
1/28/2025HouseREFERRED TO INSURANCE
1/8/2025House
Bill Text
Original
1/6/2025
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