On Tuesday, April 16, 2013, Sen. Irene Aguilar introduced SB 13-277 – Concerning the Development of a Prior Authorization Process to be Used in Obtaining Prior Approval from Carriers for Coverage of Drug Benefits. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.
The bill requires the commissioner of insurance (commissioner) to develop, by July 31, 2014, and prescribing providers, carriers, and, if applicable, pharmacy benefit management firms (PBMs), to use, by Jan. 1, 2015, a uniform prior authorization process for purposes of submitting and receiving requests for prior coverage approval of a drug benefit.
The commissioner is directed to adopt rules to establish the prior authorization process, which is to include specified components aimed at creating uniformity and reducing administrative burdens on prescribing providers, carriers, and PBMs, as well as making the criteria used for deciding prior authorization requests transparent and establishing a procedure for waiving the process under extenuating circumstances.
To assist in developing the process, the commissioner is to appoint a work group of various stakeholders to make recommendations on specified aspects of the process that the commissioner is to consider, including national standards for electronic prior authorization.
Once the prior authorization process is established, the request is deemed granted if a carrier or PBM fails to use or accept the prior authorization process, fails to notify the prescribing provider within a specified period that the request is approved or denied or that additional information is required to process the request, or fails to notify the prescribing provider within a specified period after receipt of the required additional information that the request is approved or denied. An approved prior authorization is valid for at least 180 days after the date of approval.
The bill was introduced on April 16 and assigned to the Health & Human Services Committee. The bill is scheduled for committee review on April 25 at 1:30 p.m.
Since this summary, the Senate Committee on Health and Human Services referred the bill, unamended, for consideration on Second Reading in the Senate.