A 2327: Requires disclosure, in such form as the superintendent shall require, of non-confidential information regarding step therapy override requests and determinations on a website that is readily accessible to the public.

  
  STATE OF NEW YORK ________________________________________________________________________ 2327 2025-2026 Regular Sessions  IN ASSEMBLY January 16, 2025 ___________ Introduced by M. of A. McDONALD, STECK, STIRPE, K. BROWN, COLTON, BENDETT, PAULIN, LAVINE, LUNSFORD -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law and the public health law, in relation to enhanced disclosure of step therapy override requests and determi- nations; and to repeal certain provisions of such laws relating there- to The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 4903 of the insurance law is amended by adding two 2 new subsections (j) and (k) to read as follows: 3 (j) Each health care plan and utilization review agent shall annually, 4 in such form as the superintendent shall require, report information to 5 the department regarding step therapy override requests and determi- 6 nations. Such reports shall, among other things, separately identify the 7 following information, organized by individual drug name and drug cate- 8 gory and class: 9 (1) The number of step therapy override determination requests 10 received; 11 (2) The type of health care providers or the medical specialties of 12 the health care providers submitting requests; 13 (3) The number of step therapy override determination requests that 14 were initially denied and the reasons for such denials; 15 (4) The number of step therapy override determination requests that 16 were initially approved; and 17 (5) The number of step therapy override determination requests that 18 were reversed on internal appeal. 19 (k) Each health care plan and utilization review agent shall disclose, 20 in such form as the superintendent shall require, non-confidential 21 information regarding step therapy override requests and determinations 22 on a website or web-based tool that is readily accessible to the public. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD03001-01-5 
 A. 2327 2 1 Such disclosure shall, among other things, separately identify the 2 following information, organized by individual drug name and drug cate- 3 gory and class: 4 (1) The number of step therapy override determination requests 5 received; 6 (2) The type of health care providers or the medical specialties of 7 the health care providers submitting requests; 8 (3) The number of step therapy override determination requests that 9 were initially denied and the reasons for such denials; 10 (4) The number of step therapy override determination requests that 11 were initially approved; and 12 (5) The number of step therapy override determination requests that 13 were reversed on internal appeal. 14 § 2. Section 4903 of the public health law is amended by adding two 15 new subdivisions 10 and 11 to read as follows: 16 10. Each health care plan and utilization review agent shall annually, 17 in such form as the commissioner shall require, report information to 18 the department regarding step therapy override determination requests 19 and the outcomes of such requests. Such reports shall, among other 20 things, separately identify the following information, organized by 21 individual drug name and drug category and class: 22 (a) The number of step therapy override determination requests 23 received; 24 (b) The type of health care providers or the medical specialties of 25 the health care providers submitting requests; 26 (c) The number of step therapy override determination requests that 27 were initially denied and the reasons for such denials; 28 (d) The number of step therapy override determination requests that 29 were initially approved; and 30 (e) The number of step therapy override determination requests that 31 were reversed on internal appeal. 32 11. Each health care plan and utilization review agent shall disclose, 33 in such form as the commissioner shall require, non-confidential infor- 34 mation regarding step therapy override requests and determinations on a 35 website or web-based tool that is readily accessible to the public. 36 Such disclosure shall, among other things, separately identify the 37 following information, organized by individual drug name and drug cate- 38 gory and class: 39 (a) The number of step therapy override determination requests 40 received; 41 (b) The type of health care providers or the medical specialties of 42 the health care providers submitting requests; 43 (c) The number of step therapy override determination requests that 44 were initially denied and the reasons for such denials; 45 (d) The number of step therapy override determination requests that 46 were initially approved; and 47 (e) The number of step therapy override determination requests that 48 were reversed on internal appeal. 49 § 3. Paragraph 10 of subsection (b) of section 3217-a of the insurance 50 law is REPEALED and three new subsections (h), (i) and (j) are added to 51 read as follows: 52 (h) Where applicable, each insurer subject to this article shall 53 disclose information on step therapy protocols, step therapy override 54 determinations, and internal and external appeals, as governed by arti- 55 cle forty-nine of this chapter, and any associated clinical review 56 criteria pertaining to specific conditions and diseases. Such informa- 
 A. 2327 3 1 tion shall be made readily accessible on the insurer's website or web- 2 based tool and, upon request, in written or electronic form to an 3 insured or an insured's authorized representative and a health care 4 professional as defined in subsection (f) of section four thousand nine 5 hundred of this chapter. 6 (i) If an insurer subject to this article intends either to implement 7 a new requirement or restriction or amend an existing requirement or 8 restriction, relating to a step therapy protocol, internal or external 9 step therapy appeals protocol, or associated clinical review criteria, 10 such insurer shall ensure that such new or amended requirement or 11 restriction is not implemented unless such insurer's website or web- 12 based tool has been updated to reflect such new or amended requirement 13 or restriction. 14 (j) If an insurer subject to this article intends either to implement 15 a new requirement or restriction, or amend an existing requirement or 16 restriction, relating to a step therapy protocol, internal or external 17 step therapy appeals protocol, or associated clinical review criteria, 18 such insurer shall provide any insured or health care professional as 19 defined in subsection (f) of section four thousand nine hundred of this 20 chapter who may be impacted by such new requirement, restriction, or 21 amendment with written notice of such new requirement, restriction, or 22 amendment no less than sixty days before implementation. Such notice may 23 be delivered electronically or by other means. 24 § 4. Paragraph 10 of subsection (b) of section 4324 of the insurance 25 law is REPEALED and three new subsections (h), (i) and (j) are added to 26 read as follows: 27 (h) Where applicable, each health service, hospital service, or 28 medical indemnity corporation subject to this article shall disclose 29 information on step therapy protocols, step therapy override determi- 30 nations, and internal and external appeals, as governed by article 31 forty-nine of this chapter, and any associated clinical review criteria 32 pertaining to specific conditions and diseases. Such information shall 33 be made readily accessible on such health service, hospital service, or 34 medical indemnity corporation's website or web-based tool and, upon 35 request, in written or electronic form to an insured or the insured's 36 authorized representative and a health care professional as defined in 37 subsection (f) of section four thousand nine hundred of this chapter. 38 (i) If a health service, hospital service, or medical indemnity corpo- 39 ration subject to this article intends either to implement a new 40 requirement or restriction or amend an existing requirement or 41 restriction, relating to a step therapy protocol, internal or external 42 step therapy appeals protocol, or associated clinical review criteria, 43 such health service, hospital service, or medical indemnity corporation 44 shall ensure that such new or amended requirement or restriction is not 45 implemented unless such health service, hospital service, or medical 46 indemnity corporation's website or web-based tool has been updated to 47 reflect such new or amended requirement or restriction. 48 (j) If a health service, hospital service, or medical indemnity corpo- 49 ration subject to this article intends either to implement a new 50 requirement or restriction or amend an existing requirement or 51 restriction, relating to a step therapy protocol, internal or external 52 step therapy appeals protocol, or associated clinical review criteria, 53 such health service, hospital service, or medical indemnity corporation 54 shall provide any insured or health care professional as defined in 55 subsection (f) of section four thousand nine hundred of this chapter who 56 may be impacted by such new requirement, restriction, or amendment with 
 A. 2327 4 1 written notice of such new requirement, restriction, or amendment no 2 less than sixty days before implementation. Such notice may be delivered 3 electronically or by other means. 4 § 5. Paragraph (j) of subdivision 2 of section 4408 of the public 5 health law is REPEALED and three new subdivisions 9, 10 and 11 are added 6 to read as follows: 7 9. Where applicable, each health maintenance organization subject to 8 this article shall disclose information on step therapy protocols, step 9 therapy override determinations, and internal and external appeals, as 10 governed by article forty-nine of this chapter, and any associated clin- 11 ical review criteria pertaining to specific conditions and diseases. 12 Such information shall be made readily accessible on such health mainte- 13 nance organization's website or web-based tool and, upon request, in 14 written or electronic form to an enrollee or the enrollee's authorized 15 representative and a health care professional as defined in subdivision 16 six of section forty-nine hundred of this chapter. 17 10. If a health maintenance organization subject to this article 18 intends either to implement a new requirement or restriction or amend an 19 existing requirement or restriction, relating to a step therapy proto- 20 col, internal or external step therapy appeals protocol, or associated 21 clinical review criteria, such health maintenance organization shall 22 ensure that such new or amended requirement or restriction is not imple- 23 mented unless such health maintenance organization's website or web- 24 based tool has been updated to reflect such new or amended requirement 25 or restriction. 26 11. If a health maintenance organization subject to this article 27 intends either to implement a new requirement or restriction or amend an 28 existing requirement or restriction, relating to a step therapy proto- 29 col, internal or external step therapy appeals protocol, or associated 30 clinical review criteria, such health maintenance organization shall 31 provide any enrollee or health care professional as defined in subdivi- 32 sion six of section forty-nine hundred of this chapter who may be 33 impacted by such new requirement, restriction, or amendment with written 34 notice of such new requirement, restriction, or amendment no less than 35 sixty days before implementation. Such notice may be delivered electron- 36 ically or by other means. 37 § 6. This act shall take effect immediately.