APPROVED CHAPTER
MAY 25, 2021 73
BY GOVERNOR PUBLIC LAW
STATE OF MAINE
_____
IN THE YEAR OF OUR LORD
TWO THOUSAND TWENTY-ONE
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S.P. 207 - L.D. 523
An Act Regarding Prior Authorizations for Prescription Drugs
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 24-A MRSA §4304, sub-§2, ¶D, as enacted by PL 2019, c. 273, §1, is
amended to read:
D. The prescription drug and prior authorization standards used by a carrier must be
clear and readily available to enrollees, participating providers, pharmacists and other
providers. With regard to prior authorization for prescription drugs, a carrier shall
comply with the requirements set forth in subsection 2-B. A provider must make best
efforts to provide all information necessary to evaluate a request, and the carrier must
make best efforts to limit requests for additional information.
Sec. 2. 24-A MRSA §4304, sub-§2-B, as enacted by PL 2019, c. 273, §2, is
amended to read:
2-B. Electronic transmission of prior authorization requests. Beginning no later
than January 1, 2020, if If a health plan provides coverage for prescription drugs, the carrier
must accept and respond to prior authorization requests in accordance with subsection 2
and this subsection through a secure electronic transmission using standards recommended
by a national institute for the development of fair standards and adopted by a national
council for prescription drug programs for electronic prescribing transactions. For the
purposes of this subsection, transmission of a facsimile through a proprietary payer portal
or by use of an electronic form is not considered electronic transmission. A carrier's
electronic transmission system for prior authorization requests for prescription drugs must
comply with the following.
A. No later than January 1, 2022, unless a waiver is granted by the superintendent, a
carrier or entity under contract to a carrier shall make available to a provider in real
time at the point of prescribing one or more electronic benefit tools that are capable of
integrating with at least one electronic prescribing system or electronic medical record
system to provide complete, accurate, timely, clinically appropriate formulary and
benefit information specific to an enrollee, including, but not limited to, the estimated
cost-sharing amount to be paid by the enrollee, information on any available formulary
alternatives that are clinically appropriate and information about the formulary status
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 and the utilization review and prior authorization requirements of each drug presented.
Upon a carrier's request, the superintendent may grant a waiver from the requirements
of this paragraph based on a demonstration of good cause.
B. No later than January 1, 2023, unless a waiver is granted by the superintendent, a
carrier or entity under contract to a carrier shall make available to a provider in real
time at the point of prescribing an electronic benefit tool that is capable of integrating
with the provider's electronic prescribing system or electronic medical record system
to provide complete, accurate, timely, clinically appropriate formulary and benefit
information specific to an enrollee, including, but not limited to, the estimated cost-
sharing amount to be paid by the enrollee, information on any available formulary
alternatives that are clinically appropriate and information about the formulary status
and the utilization review and prior authorization requirements of each drug presented.
Upon a carrier's request, the superintendent may grant a waiver from the requirements
of this paragraph based on a demonstration of good cause.
Sec. 3. Bureau of Insurance to monitor compliance. Beginning January 1,
2022, the Department of Professional and Financial Regulation, Bureau of Insurance shall
monitor compliance by carriers authorized to do business in this State with the requirements
of the Maine Revised Statutes, Title 24-A, section 4304, subsection 2-B using its authority
under Title 24-A, section 221. The bureau shall also request information from carriers on
the adoption and usage of electronic transmission by health care providers for requesting
prior authorization for prescription drugs from carriers. No later than June 1, 2023, the
bureau shall submit a report to the joint standing committee of the Legislature having
jurisdiction over health coverage and insurance matters on the status of compliance by
carriers. If the bureau determines that a carrier is not complying with the requirements of
Title 24-A, section 4304, subsection 2-B, the bureau shall take enforcement action against
the carrier as appropriate. The joint standing committee of the Legislature having
jurisdiction over health coverage and insurance matters may report out a bill to the Second
Regular Session of the 131st Legislature based on the report.
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Statutes affected:
Bill Text LD 523, SP 207: 24-A.4304
Bill Text ACTPUB , Chapter 73: 24-A.4304