In late December Gov. Kathy Hochul signed step therapy reform bill S.1276a/A901a by Senator Neil Breslin (46/D) and Assemblyman John McDonald III (108/D) into law, following a long effort by patient and provider groups from across New York State and national advocacy organization Aimed Alliance. 

The bill places guardrails on the use of step therapy by state regulated health plans (incl. Medicaid, commercial plans, and ACA/NY state exchange plans, but not self-funded plans) such as:  

• Prohibits off-label stepping;

• Limits step therapy to no more than 2 drugs;

• Limits step therapy to no more than 30 days or a timeline established by current evidence-based guidelines; and

• Requires health plans to accept a health care provider's attestation that a patient has tried and failed on a medication previously. 

The new law takes effect 1/1/26 to give health plans time to adjust their policies. 

Step therapy is a form of utilization management used by health plans and PBMs to cut costs by requiring patients to try one or more less expensive medications before they can receive the medication originally prescribed. Step therapy is an issue  for people with serious medical conditions because it can delay their treatment and lead to a worsening of their condition. Read a FAQ about the new step law here.

This bill builds on a 2016 New York law. Several other states have adopted or are considering step therapy reform, and many patient organizations are pushing for a national step therapy reform bill called the "Safe Step Act" to address this problematic practice.