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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 | history

SUMMARY AS PASSED HOUSE:

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.

SUMMARY AS INTRODUCED:

Health insurance; prior authorization for drug benefits. Requires health insurance provider contracts under which a carrier has the right or obligation to require prior authorization for a drug benefit contain specific provisions that, among other things, (i) accept universal prior authorization forms; (ii) permit the electronic submission of prior authorization requests using certain electronic submission formats; (iii) address when prior authorization may be required for chronic disease management drug benefits and mental health drug benefits; (iv) require that prior authorization approved by another carrier be honored for the initial 90 days of an insured's prescription drug benefit coverage upon the carrier's receipt from the prescriber of a record demonstrating the previous carrier's prior authorization approval; (v) address when prior authorization requests are deemed to be approved; (vi) require that, if a prior authorization request is approved by the carrier, the prior authorization approval be valid for not less than one year; (vii) limit when prior authorization may be required for generic drug benefits; (viii) require that a tracking number be assigned by the carrier to all prior authorization requests and that the tracking number be provided electronically to the prescriber upon the carrier's receipt of the prior authorization request; and (ix) require that the carrier's prescription drug formularies, all drug benefits subject to prior authorization by the carrier, all of the carrier's prior authorization procedures, and all prior authorization request forms accepted by the carrier be centrally located on the carrier's website and that such postings be updated by the carrier within seven days of approved changes. These requirements do not apply when the carrier has evidence of fraud, waste, or abuse by the insured or the prescriber. The measure also requires certain entities to develop, and annually update, universal prior authorization forms and to provide the forms to the State Corporation Commission. The State Corporation Commission is required to make the universal prior authorization forms available on or before January 1, 2016, and to make revised universal prior authorization forms available annually thereafter.