This bill aims to revise laws related to prior authorization for health care services in Montana, specifically extending the duration of prior authorization certifications and prohibiting prior authorization for certain prescriptions. The bill amends Section 33-32-102 to include a new definition of "chronic condition," which is defined as a condition lasting one year or more that requires ongoing medical attention or limits daily activities. Additionally, it establishes that prior authorization for the treatment of a chronic condition will be valid for the duration of that condition, eliminating the need for re-certification as long as the condition persists.

Furthermore, the bill amends Section 33-32-107 to extend the validity of prior authorization certifications from three months to twelve months, with the exception that certifications for chronic conditions remain valid for the duration of the condition. It also amends Section 33-32-221 to prohibit prior authorization for certain prescription drugs, including generic drugs not listed as controlled substances after six months of uninterrupted use, and specific medications for substance use disorders. The bill ensures that if an adverse determination is made during prior authorization, the health insurance issuer must provide a written notice that includes a list of reasonable therapeutic alternatives covered by the insurer's formulary.

Statutes affected:
LC Text: 33-32-102, 33-32-107, 33-32-221