New York Assembly Bill A07522

New York 2025-2026 Regular Session

• Introduced: 4/1/25
• Refer: 4/1/25
• Refer: 1/7/26

Caption

Prohibits the application of fail-first or step therapy protocols to coverage for the diagnosis and treatment of serious mental health conditions; defines serious mental health condition.

Summary

This bill amends New York insurance law to bar insurers from using fail-first or step therapy protocols, and prior authorization requirements, for drugs prescribed to treat defined “serious mental health conditions.” It also extends existing mental health parity provisions to explicitly include outpatient drug coverage in the affected policy and contract sections. The bill applies to health insurance policies and contracts that cover physician services and outpatient mental health care, and it preserves existing language stating that it does not create a new mandated health benefit or expand the scope of practice for certain licensed providers. The bill defines “serious mental health condition” to include a specified list of disorders, including neurodevelopmental disorders, schizophrenia spectrum and other psychotic disorders, bipolar disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, trauma-and-stressor-related disorders, neurodegenerative disorders, and substance-related and addictive disorders. It also updates gendered language in the statute to gender-neutral wording. The effective date is the first January 1 after enactment, and it applies to policies and contracts issued, renewed, modified, altered, or amended on or after that date.

Impact

The bill would amend sections 3216, 3221, and 4303 of the Insurance Law, which govern health insurance policies and contracts in New York. Its main legal effect is to prohibit insurers from imposing step therapy or prior authorization on medications used to treat serious mental health conditions, while also clarifying that outpatient drug coverage is included within the mental health parity protections already in those sections. Insurers offering covered physician services would need to adjust utilization management practices and coverage rules for the specified mental health diagnoses.

Sentiment

The available record shows no committee transcript or recorded votes, so there is no direct evidence of debate or opposition in the materials provided. Based on the bill’s purpose and structure, the measure appears to be framed as a patient-access and mental health parity bill, suggesting generally supportive intent from sponsors and likely advocates for mental health treatment access. The absence of recorded dissent in the provided context means sentiment cannot be measured beyond the bill’s pro-access design.

Contention

The most likely point of contention is the restriction on insurer utilization management tools, especially step therapy and prior authorization, because those tools are commonly defended by insurers as cost-control and medical-management mechanisms. Another possible issue is the bill’s definition of “serious mental health condition,” which is broad and includes substance-related and addictive disorders as well as neurodegenerative disorders, potentially raising questions about scope and implementation. The bill also preserves language stating it does not create a new mandated benefit, which suggests sensitivity to concerns about expanding insurer obligations.