Select health plans have recently alleged that their step-therapy policies, that were titled “medical necessity policies”, were not governed by the NY step therapy law based on a Q&A from the NY Department of Financial Services (DFS) 54(11.4%). Aimed Alliance disagreed with this interpretation and sought clarification from DFS regarding whether a medical necessity policy that operates as a step-therapy policy is subject to the step-therapy law.
DFS recently confirmed that Aimed Alliance’s interpretation of the law was correct. Specifically, DFS stated :
““. . . Insurance Law § 4900(g-9) defines step therapy protocol to mean a policy, protocol or program established by a utilization review agent that establishes the specific sequence in which prescription drugs for a specified medical condition are approved for an insured. If the policy in operation meets the definition of a step therapy protocol then it would be deemed a step therapy policy.”
Last Updated on June 26, 2023 by Aimed Alliance
