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H.B. 323





Chief Sponsor: Bradley G. Last

Senate Sponsor: ____________

             7      LONG TITLE
             8      General Description:
             9          This bill amends the Insurance Code related to health insurance and prior authorization
             10      forms for prescription drugs.
             11      Highlighted Provisions:
             12          This bill:
             13          .    defines terms;
             14          .    requires the commissioner of insurance to adopt rules by July 1, 2013, to
             15      standardize the prior authorization forms required by health insurers for prescription
             16      drugs;
             17          .    requires public input for the administrative rules; and
             18          .    requires the health insurers to accept the standard form and reply to the standard
             19      form within two days after submission of the form.
             20      Money Appropriated in this Bill:
             21          None
             22      Other Special Clauses:
             23          None
             24      Utah Code Sections Affected:
             25      ENACTS:
             26          31A-22-635.5, Utah Code Annotated 1953

             28      Be it enacted by the Legislature of the state of Utah:
             29          Section 1. Section 31A-22-635.5 is enacted to read:
             30          31A-22-635.5. Uniform prescription drug prior authorization form.
             31          (1) For purposes of this section, "health insurer" is as defined in Subsection
             32      31A-22-634 (1).
             33          (2) The commissioner shall on or before July 1, 2013, adopt an administrative rule to:
             34          (a) prescribe a form for requesting prior authorization of prescription drug benefits;
             35          (b) require a health insurer to use the form for any prior authorization of prescription
             36      drug benefits required by the plan;
             37          (c) require that the department and a health insurer make the form available
             38      electronically; and
             39          (d) allow a completed form to be submitted electronically by the prescribing provider
             40      to the health insurer or the agent of the health insurer that manages or administers prescription
             41      drug benefits.
             42          (3) An administrative rule adopted by the commissioner under this section shall:
             43          (a) limit the form, as printed, to not more than two pages;
             44          (b) develop the form with input from interested parties received at one or more public
             45      meetings; and
             46          (c) take into consideration:
             47          (i) any form for requesting prior authorization of benefits that is widely used in this
             48      state or any form currently used by the department;
             49          (ii) request forms for prior authorization of benefits established by the federal Centers
             50      for Medicare and Medicaid Services; and
             51          (iii) national standards, or draft standards, pertaining to electronic prior authorization
             52      of benefits.
             53          (4) If a health insurer fails to use or accept the form required by this section, or fails to
             54      respond within two business days of receipt to a completed form submitted by a prescribing
             55      provider, the prior authorization is considered granted by the health insurer.

Legislative Review Note
    as of 2-8-13 11:39 AM

Office of Legislative Research and General Counsel

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