Senate Bill 2086

AN ACT TO PRESCRIBE A STANDARDIZED PRIOR AUTHORIZATION FORM FOR PRESCRIPTION DRUGS TO INCLUDE ELECTRONIC AVAILABILITY AND PRIOR FORMS ESTABLISHED BY THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES; TO AUTHORIZE THE MISSISSIPPI BOARD OF PHARMACY TO PROMULGATE RULES AND REGULATIONS NECESSARY TO DEVELOP THE PRIOR AUTHORIZATION FORM; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. As used in this section, the following words and phrases, whenever used in this act, shall be construed as defined in this section:

(a) "Health insurance issuer" means any entity that offers health insurance coverage through a plan, policy, or certificate of insurance subject to state law as defined in Section 83-1-101, Mississippi Code of 1972.

(b) "Health benefit plan" means any plan, benefit, or health insurance coverage with services consisting of medical care provided directly, through insurance or reimbursement, or otherwise, and including items and services paid for as medical care under any hospital or medical service policy or certificate, hospital or medical service plan contract, preferred provider organization, or health maintenance organization contract offered by a health insurance issuer. However, excepted benefits are not included as a "health benefit plan."

(c) "Prior authorization" shall mean a utilization management criteria utilized to seek permission or waiver of a drug to be covered under a health benefit plan that provides prescription drug benefits.

(d) "Prior authorization form" shall mean a standardized, uniform application developed for the purpose of obtaining prior authorization.

(e) "Board" shall mean the Board of Pharmacy as defined in Section 73-21-75, Mississippi Code of 1972.

SECTION 2. (1) Notwithstanding any other provisions of this act, on and after January 1, 2014:

(a) A health insurance issuer that provides prescription drug benefits shall accept only the prior authorization form developed pursuant to subsection (2)(a) of this section when requiring prior authorization for prescription drug benefits.

(b) If a health insurance issuer fails to utilize or accept the prior authorization form, or fails to respond within two (2) business days upon receipt of a completed prior authorization request from a prescribing provider, pursuant to the submission of the prior authorization form developed as described in subsection (2)(a) of this section the prior authorization request shall be deemed to have been granted.

(2) The Board of Pharmacy shall develop a uniform prior authorization form.

(a) The prior authorization form developed shall meet the following criteria:

(i) The form shall not exceed two (2) pages.

(ii) The form shall be made available electronically by the board and the health care service plan.

(iii) The completed form may also be submitted electronically from the prescribing provider to the health care service plan.

(iv) The board shall develop the form with input from interested parties received at one or more public meetings.

(v) The board, in developing the standardized form, shall take into consideration the following:

1. Existing prior authorization forms established by the federal Centers for Medicare and Medicaid Services.

2. National standards, or draft standards, pertaining to electronic prior authorization.

(b) The board shall promulgate rules and regulations necessary to effectuate this provision by November 1, 2013.

(c) Notwithstanding any other provision of this chapter to the contrary, on and after January 1, 2014, every health insurance issuer shall use such uniform prior authorization form to request prior authorization for coverage of prescription drug benefits and every health care service plan shall accept such form as sufficient to request prior authorization for prescription drug benefits.

SECTION 3. This act shall take effect and be in force from and after July 1, 2013.