A. After January 1, 2014, an insurer shall accept the uniform prior authorization form developed pursuant to Sections 2 [59A-2-9.8 NMSA 1978] and 3 [61-11-6.2 NMSA 1978] of this 2013 act as sufficient to request prior authorization for prescription drug benefits.
B. No later than twenty-four months after the adoption of national standards for electronic prior authorization, a health insurer shall exchange prior authorization requests with providers who have e-prescribing capability.
C. If an insurer fails to use or accept the uniform prior authorization form or fails to respond within three business days upon receipt of a uniform prior authorization form, the prior authorization request shall be deemed to have been granted.
D. As used in this section, "insurer":
(1) means:
(a) an insurer;
(b) a nonprofit health service provider;
(c) a health maintenance organization;
(d) a managed care organization; or
(e) a provider service organization; and
(2) does not include:
(a) a person that delivers, issues for delivery or renews an individual policy intended to supplement major medical group-type coverages such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or other limited-benefit health insurance policy;
(b) a physician or a physician group to which a health insurer has delegated financial risk for prescription drugs and that does not use a prior authorization process for prescription drugs; or
(c) an insurer or its affiliated providers, if the insurer owns and operates its pharmacies and does not use a prior authorization process for prescription drugs.
History: Laws 2013, ch. 170, § 6.
Effective dates. — Laws 2013, ch. 170 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 14, 2013, 90 days after the adjournment of the legislature.
Structure New Mexico Statutes
Article 23 - Group and Blanket Health Insurance Contracts
Section 59A-23-1 - Scope of article.
Section 59A-23-2 - Blanket health insurance.
Section 59A-23-3 - Group health insurance.
Section 59A-23-3.1 - Group insurance reports required.
Section 59A-23-4 - Other provisions applicable.
Section 59A-23-5 - Extended disability benefit.
Section 59A-23-6 - Alcohol dependency coverage.
Section 59A-23-6.1 - Coverage of alpha-fetoprotein IV screening test.
Section 59A-23-6.2 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.
Section 59A-23-7.2 - Coverage of children.
Section 59A-23-7.3 - Maximum age of dependent.
Section 59A-23-7.4 - Coverage of circumcision for newborn males.
Section 59A-23-7.5 - Coverage of part-time employees.
Section 59A-23-7.6 - Coverage of colorectal cancer screening.
Section 59A-23-7.7 - General anesthesia and hospitalization for dental surgery.
Section 59A-23-7.8 - Hearing aid coverage for children required.
Section 59A-23-7.9 - Coverage for autism spectrum disorder diagnosis and treatment.
Section 59A-23-7.11 - Coverage of prescription eye drop refills.
Section 59A-23-7.12 - Coverage for telemedicine services.
Section 59A-23-7.13 - Prescription drugs; prohibited formulary changes; notice requirements.
Section 59A-23-7.14 - Coverage for contraception.
Section 59A-23-7.15 - Coverage exclusion. (Contingent repeal. See note.)
Section 59A-23-7.16 - Heart artery calcium scan coverage.
Section 59A-23-8 - Group formed to purchase health insurance; limitations.
Section 59A-23-10 - Employer utilization and loss data availability.
Section 59A-23-11 - Private health insurance cooperatives; incorporation.
Section 59A-23-12 - Prescription drug prior authorization protocols.
Section 59A-23-12.2 - Pharmacist prescriptive authority services; reimbursement parity.
Section 59A-23-13 - Pharmacy benefits; prescription synchronization.
Section 59A-23-14 - Provider credentialing; requirements; deadline.
Section 59A-23-15 - Physical rehabilitation services; limits on cost sharing.