NYAPRS Note: The following comes courtesy of Politico’s Dan Goldberg, describing the achievement of one of NYAPRS’ advocacy priorities for last year’s legislative session. Many NYAPRS members have sought to limit if not ban health plan related barriers in getting the medication that they prefer and that their prescribers order.
Gov. Andrew Cuomo signed a bill Saturday changing the rules surrounding step therapy, a process by which insurers can require that certain drugs be tried first before approving a physician's prescription.
The bill , which passed unanimously in the state Senate and Assembly, does not ban the use of step therapy, but does provide rules governing how physicians may appeal an insurer's decision and how long an insurer has to answer that appeal.
The new law requires insurers to provide an answer to the appeal within 72 hours, or 24 hours in case of emergency. The bill was opposed by the New York Health Plan Association, a trade group representing insurers, which worried about vague language in the law that could let physicians declare their preference is in the "best interest of the patient" - a subjective term - and override an insurer's decision