New York S 4689: Relates to reporting information regarding step therapy override requests and determinations; repealer

Bill Text

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S04689 Summary:

BILL NOS04689 

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SAME ASSAME AS A02327

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SPONSORCLEARE

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COSPNSR

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MLTSPNSR

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Amd §§4903 & 4408, rpld §4408 sub 2 ¶(j), Pub Health L; rpld §3217-a sub§ (b) ¶10, §4324 sub§ (b) ¶10, amd
§§3217-a, 4903 & 4324, Ins L

&nbsp

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.

Go to top S04689 Actions:

BILL NOS04689 

&nbsp

02/11/2025REFERRED TO INSURANCE

01/07/2026REFERRED TO INSURANCE

Go to topS04689 Committee&nbspVotes:

Go to topS04689 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topS04689 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 4689

 2025-2026 Regular Sessions

 IN SENATE

 February 11, 2025
 ___________

 Introduced by Sen. CLEARE -- read twice and ordered printed, and when
 printed to be committed 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.
 23 Such disclosure shall, among other things, separately identify the

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD03001-01-5

 S. 4689 2

 1 following information, organized by individual drug name and drug cate-
 2 gory and class:
 3 (1) The number of step therapy override determination requests
 4 received;
 5 (2) The type of health care providers or the medical specialties of
 6 the health care providers submitting requests;
 7 (3) The number of step therapy override determination requests that
 8 were initially denied and the reasons for such denials;
 9 (4) The number of step therapy override determination requests that
 10 were initially approved; and
 11 (5) The number of step therapy override determination requests that
 12 were reversed on internal appeal.
 13 § 2. Section 4903 of the public health law is amended by adding two
 14 new subdivisions 10 and 11 to read as follows:
 15 10. Each health care plan and utilization review agent shall annually,
 16 in such form as the commissioner shall require, report information to
 17 the department regarding step therapy override determination requests
 18 and the outcomes of such requests. Such reports shall, among other
 19 things, separately identify the following information, organized by
 20 individual drug name and drug category and class:
 21 (a) The number of step therapy override determination requests
 22 received;
 23 (b) The type of health care providers or the medical specialti