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2015 SESSION

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HB 1942 Health insurance; carrier business practices, prior authorization provisions.

Introduced by: Gregory D. Habeeb | all patrons    ...    notes | add to my profiles

SUMMARY AS PASSED HOUSE: (all summaries)

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 SB 1262.


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