New YorkA 4432025-2026 Regular SessionHouseWALLET

Relates to step therapy protocol

Sponsored By: John T. McDonald III (Democratic)

Became Law

INSURANCERULES

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 2 benefits, 0 costs, 0 mixed.

Fairer rules for step therapy coverage

Your plan cannot require drugs that are not FDA-approved for your condition or not backed by current guidelines. It cannot make you try more than two drugs, or keep you on a step drug longer than 30 days or the time in current guidelines. Step therapy is not allowed if no therapeutic equivalent exists, or if the plan covered the same drug for you in the last 365 days. If you switch plans, you do not repeat a step protocol finished in the last 365 days once you or your provider sends proof. After a formulary change, a drug already approved for you stays covered without step therapy until the override expires, unless a current safety risk and a different alternative exist.

Faster step therapy overrides and coverage

Your prescriber can send a written or electronic attestation that a required drug failed, and the plan must accept it as proof. When an override is approved, coverage for the prescribed drug starts right away and lasts for the shorter of the guideline treatment time or 12 months after approval or your coverage renewal. If the reviewer misses legal deadlines, the law treats that as an automatic override that you can appeal. If the reviewer fails to follow the step therapy rules (absent fraud), that is valid grounds to grant an override.

Sponsors & Cosponsors

Sponsor

John T. McDonald III
Democratic • House

Cosponsors

MaryJane Shimsky
Democratic • House

Roll Call Votes

All Roll Calls

Yes: 60 • No: 1

House vote • 2/11/2025

FLOOR Vote