Listed below is an update from MHANYS Public Policy Director, John Richter on the passage today of legislation that enhances consumer protections around step therapy protocols. This is an important step forward for consumer protections and we will advocate for the Governor to sign this legislation.
Success! Both the New York State Assembly and the Senate have passed A.901-A (McDonald)/S.1267-A (Breslin), which will ensure that consumers are protected from unreasonable step therapy protocols. MHANYS urges Governor Hochul to sign the legislation.
Step therapy is a process by which insurers (public or private) require patients to take one or more alternative medications before they can access the medicine prescribed by their provider. MHANYS thanks Assemblymember John T. McDonald and Senator Neil Breslin for their leadership on this critically important issue. For the past several years MHANYS has worked alongside fellow advocates to pass this legislation. Thanks to Aimed Alliance for their persistent efforts in leading this coalition.
Specifically, the legislation will require that step therapy protocols established by a utilization review agent must require the use of a prescription drug that
is approved by the FDA for treatment of the medical condition and/or be supported by current evidence-based clinical guidelines, and:
- only require an insured person to try and fail on two drugs within one therapeutic category before providing coverage of the prescribed drug;
- only require an insured to try a step-therapy required drug for 30 days or less or a duration of treatment supported by current evidence-based for the medical condition being treated, and
- only be imposed on an insured if a therapeutic equivalent to the prescribed drug is available.
A step therapy protocol cannot require a newly insured person to repeat step therapy for a prescribed drug where that insured already completed step therapy for that drug under a prior plan, so long as the enrollee or provider submits information demonstrating completion of a step therapy protocol of the prior plan within the past 365 days or be imposed on an insured for a prescribed drug that was previously approved for coverage by a plan for a specific medical condition after the insured’s plan implements a formulary change or utilization management that impacts the coverage criteria for the prescribed drug the approved override expires unless a specifically identified and current evidence-based safety concern exists and a different therapeutic alternative drug exists.
