Pharmacy Benefit Reform - New York S.1267-A

Jan 16, 2025

Although Congress chose not to include Pharmacy Benefit Reform (PBM) in the 2024 lame-duck package, states like New York have taken bold steps to address critical areas of healthcare reform imposed by insurance companies and PBMs. 

In a significant win for patients and practitioners, New York Governor Kathy Hochul signed S.1267-A into law. A decisive move to limit onerous step therapy policies and increase timely access to treatment for patients. 

Step therapy, often referred to as “fail-first” policies, requires patients to try and fail one or more insurer-preferred treatments before being approved for originally prescribed medication. These policies often delay access to appropriate care, significantly hindering patient outcomes.

Under S.1267-A, health plans in New York will be required to accept attestations from practitioners regarding previously failed treatments, streamlining the appeals process and ensuring patients receive timely access to care. This new law curtails the excessive access barriers and burdensome paperwork previously required, allowing health care teams to respond to patient needs in a timely manner. 

The success of S.1267-A was made possible through the advocacy efforts of many organizations, including the Society of Dermatology Physician Associates (SDPA). SDPA was successful in mobilizing New York members to send letters and call the Governor’s office urging them to sign this bill. Grassroots efforts like these highlight the real-world impact of DermPAs utilizing their voices to support patient-centered reform. 

While Congress has yet to address PBM reform comprehensively, New York has set a precedent for other states to follow. By prioritizing patient care above insurer’s bottom line, S.1267-A represents a meaningful step towards ensuring equitable access to care.

As more states look to tackle PBM reform in 2025, New York’s success serves as a model for advocacy and legislative impact.