This bill amends the Prior Authorization Act to prohibit health insurers from requiring prior authorization for specific covered services, including chemotherapy, dialysis, elder care, and home health care services. The bill establishes that while prior authorization is not required, insurers may still request notification from healthcare providers after the initiation of these services and may require the submission of a treatment plan that complies with federal law.

Additionally, the bill modifies existing provisions regarding prior authorization for prescription drugs. It specifies that medications approved by the FDA for treating autoimmune disorders, cancer, diabetes, high blood pressure, or substance use disorders will not be subject to prior authorization, except when a biosimilar, interchangeable biologic, or generic version is available. This aims to streamline access to necessary treatments and reduce barriers for patients requiring these essential services.

Statutes affected:
introduced version: 59A-22B-1, 59A-22B-8