PRIOR AUTHORIZATION & PRESCRIPTION DRUGS

Added Pharmacy Benefits Managers to the entities subject to Prior Authorization Act requirements

Added new definitions for 'chronic health condition', 'chronic maintenance drug', 'serious mental illness', and 'off-label' medication

Prohibited prior authorization for drugs treating serious mental illness, autoimmune disorders, cancer, rare diseases, and substance use disorders

Limited prior authorization for chronic maintenance drugs to no more than once every three years with specific exceptions

Restricted step therapy requirements for serious mental illness and rare disease treatments, with exceptions only for minors or institutionalized patients

Required electronic portals for 24/7 prior authorization requests and auto-adjudication of electronically transmitted requests

Changed prior authorization decision timelines from seven days to three days for standard requests and twenty-four hours for emergency requests

Added requirements for the office to maintain a complaint log and impose fines up to $5,000 for non-compliance

Added new definitions for 'auto-adjudicate' (using technology for near-real-time decisions) and 'pharmacy benefits manager' to clarify who must comply with the law.

Changed prior authorization requirements for chronic maintenance drugs to limit them to once every three years, unless specific exceptions like fraud or FDA actions occur.

Added requirement that prior authorization requests be auto-adjudicated electronically within 24 hours for standard cases and 24 hours for expedited emergency cases.

Prohibited step therapy requirements for medications treating autoimmune disorders, cancer, rare diseases, serious mental illness, and substance use disorders.

Established new enforcement mechanisms including fines up to $5,000 for non-compliance and required annual reporting to the governor and legislature.

Extended applicability date to January 1, 2027, and modified deadlines for prior authorization decisions from 7 days to 3 business days for standard requests.