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 new provisions allow health insurers to require notification from healthcare providers after the initiation of these services and to request the submission of treatment plans that comply with federal law.

Additionally, the bill modifies existing language regarding prior authorization for prescription drugs, expanding the list of conditions for which prior authorization is prohibited to include diabetes, high blood pressure, and substance use disorders, alongside autoimmune disorders and cancer. The bill maintains that prior authorization and step therapy requirements cannot be imposed if a biosimilar, interchangeable biologic, or generic version of the medication is available.

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