Health insurers must respond to a step therapy override request within 72 hours of the request. A health insurer is required to respond within 24 hours if the request is for a patient with a medical condition that places the health of the patient in serious jeopardy without the prescription drug or drugs prescribed by the patient’s physician. If the health insurer fails to act within these 72 or 24-hour time periods, the request will be granted in favor of the patient.
The new law also requires that health insurers’ step therapy protocols be based on evidence-based and peer-reviewed clinical criteria that also take into account the needs of atypical patients. These criteria must be made available to physicians upon request.
Webinar: How to override a health insurer’s step therapy protocol
Template for physicians/staff to use in requesting a step therapy protocol override
File a complaint with the Office of the NY Attorney General