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2015 SESSION

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SB 1262 Health insurance; carrier business practices.

Introduced by: Stephen D. Newman | all patrons    ...    notes | add to my profiles | history

SUMMARY AS PASSED:

Health insurance plans and programs; preauthorization for drug benefits. Requires certain health insurance contracts under which an insurance carrier or its intermediary has the right or obligation to require preauthorization for a drug benefit to include provisions governing the preauthorization process. Required provisions address (i) acceptance by carriers of telephonic, facsimile, or electronic submission of prior authorization requests that are delivered from e-prescribing systems, electronic health record systems, and health information exchange platforms that utilize certain standards; (ii) time limits for communicating to the prescriber that a request is approved, denied, or requires supplementation; (iii) providing reasons for denial of a request; (iv) honoring a prior authorization approved by another carrier; (v) use of a tracking system for prior authorization requests; and (vi) making formularies, drug benefits subject to prior authorization, prior authorization procedures, and certain forms available through the carrier's website. The measure also requires certain organizations to convene a workgroup to identify common evidence-based parameters for carrier approval of certain prescription drugs. This bill is identical to HB 1942.

SUMMARY AS PASSED SENATE:

Health insurance plans and programs; preauthorization for drug benefits. Requires certain health insurance contracts under which an insurance carrier or its intermediary has the right or obligation to require preauthorization for a drug benefit to include provisions governing the preauthorization process. Required provisions address (i) acceptance by carriers of telephonic, facsimile, or electronic submission of prior authorization requests that are delivered from e-prescribing systems, electronic health record systems, and health information exchange platforms that utilize certain standards; (ii) time limits for communicating to the prescriber that a request is approved, denied, or requires supplementation; (iii) providing reasons for denial of a request; (iv) honoring a prior authorization approved by another carrier; (v) use of a tracking system for prior authorization requests; and (vi) making formularies, drug benefits subject to prior authorization, prior authorization procedures, and certain forms available through the carrier's website. The measure also requires certain organizations to convene a workgroup to identify common evidence-based parameters for carrier approval of certain prescription drugs.

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SUMMARY AS INTRODUCED:

Health insurance plans and programs; preauthorization for drug benefits. Requires certain health insurance contracts under which an insurance carrier or its intermediary has the right or obligation to require preauthorization for a drug benefit to include provisions governing the preauthorization process. Required provisions address (i) use of a common preauthorization form to be developed by the State Corporation Commission, (ii) the electronic submission of preauthorization requests, (iii) waiving preauthorization requirements for chronic disease management drug benefits and for mental health drug benefits, (iv) requests for supplementation of a preauthorization or waiver request, (v) preauthorization restrictions for generic drug benefits, and (vi) posting of certain information. These provisions are also applicable to Medicaid fee-for-service and Medicaid managed care health plans and the state employee health insurance program.