2013 New Mexico Statutes
Chapter 59A - Insurance Code
Article 22 - Health Insurance Contracts
Section 59A-22-52 - Prescription drug prior authorization protocols. (2013)


NM Stat § 59A-22-52 (2013) What's This?

59A-22-52. Prescription drug prior authorization protocols. (2013) 
A.   After January 1, 2014, a health insurer shall accept the uniform prior authorization form developed pursuant to Sections 2 and 3 of this 2013 act as sufficient to request prior authorization for prescription drug benefits.
B.   No later than twenty-four months after the adoption of national standards for electronic prior authorization, a health insurer shall exchange prior authorization requests with providers who have e-prescribing capability.
C.   If a health insurer fails to use or accept the uniform prior authorization form or fails to respond within three business days upon receipt of a uniform prior authorization form, the prior authorization request shall be deemed to have been granted.
D.   As used in this section, "health insurer":
(1)   means:
(a)   a health insurer; 
(b)   a nonprofit health service provider;
(c)   a health maintenance organization;
(d)   a managed care organization; or
(e)   a provider service organization; and
(2)   does not include:
(a)   a person that delivers, issues for delivery or renews an individual policy intended to supplement major medical group-type coverages such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or other limited-benefit health insurance policy;
(b)   a physician or a physician group to which a health insurer has delegated financial risk for prescription drugs and that does not use a prior authorization process for prescription drugs; or 
(c)   a health insurer or its affiliated providers if the health insurer owns and operates its pharmacies and does not use a prior authorization process for prescription drugs.
History: Laws 2013, ch. 170 , § 5.

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