Step therapy polices, also known as “fail first,” are a practice used by insurers and pharmacy benefit managers (PBMs) to require consumers to try and fail on alternative treatments, before the insurer or PBM will cover the originally prescribed treatment. In 2016, New York passed a step therapy law, which places certain guardrails on step therapy policies such as requiring a utilization review agents to use evidence-based and peer reviewed clinical review criteria when establishing a step therapy protocol; and imposing 24 and 72 hour timelines for approving exception requests.
Despite New York’s efforts to place guardrails and consumer protections on step-therapy policies, a 2019 survey conducted by Aimed Alliance showed that New York health care practitioners, were still finding the step therapy process burdensome and harmful for patients. In response to this survey, Aimed Alliance has worked with a group of nonprofits, patient advocacy organizations, professional associations, regulators, and legislative officials to determine how the current New York step therapy law could be improved to better protect patients’ access to their necessary medications.
In 2023, Senator Breslin and Assemblyman McDonald introduced four bills to address the gaps in the current law. Learn more about these bills by reading Aimed Alliance’s new fact sheet, here.
Last Updated on February 17, 2023 by Aimed Alliance
