The bill amends the Prior Authorization Act to expand the categories of drugs that are exempt from prior authorization and step therapy protocols. Specifically, it prohibits health insurers from requiring prior authorization for medications approved by the FDA that are prescribed for the treatment of autoimmune disorders, cancer, rare diseases, or substance use disorders, provided that a medical necessity determination is made by a qualified healthcare professional. Additionally, the bill mandates that these determinations be automatically approved within specified timeframes, ensuring timely access to necessary medications.

Furthermore, the bill establishes that health insurers cannot impose step therapy requirements for off-label medications prescribed for rare diseases or conditions, again contingent on a medical necessity determination. The provisions of this act will apply to any individual or group health insurance policies issued on or after July 1, 2025, thereby enhancing access to critical treatments for patients with specific medical conditions while streamlining the authorization process for healthcare providers.

Statutes affected:
introduced version: 59A-22B-2, 59A-22B-5, 59A-22B-8
Final Version: 59A-22B-2, 59A-22B-5, 59A-22B-8