Health Insurance Prior Authorization Act Unanimously Passes Senate

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Health Insurance Prior Authorization Act Unanimously Passes Senate

Santa Fe—The New Mexico State Senate passed unanimously SB 188, co-sponsored by Senator Gay Kernan (R-District 42). It is designed to alleviate many of the frustrations medical doctors have getting their patients pre-authorizations from insurance companies for medically necessary medicines and medical procedures.  Senator Kernan said SB 188 would streamline and reduce the prior authorization process that insurance companies require, making patients’ and doctors’ lives better.

“For several years the number one complaint heard from the New Mexico Medical Society (NMMS) and American Medical Association (AMA) memberships is the frustration with the ever increasing time and money spent on successfully completing prior authorizations requirements for insurance companies,” Senator Kernan told her colleagues.  “The time that it is taking to complete the paperwork for prior authorization, could be better spent on patients and tending to their needs. Let’s take the frustration away from our doctors and give them more time to do what they do best- treating their patients. Let’s streamline the process.”

SB188 would enact a Prior Authorization Act to improve prior authorization process used by New Mexico health insurance providers and pharmacy benefit managers. It requires the Office of Superintendent of Insurance  to standardize and streamline the process for non-emergency medical care or related benefits. The Act was crafted with extensive input from NMMS members throughout the state. 

The bill makes new requirements on health insurance providers and pharmacy benefit managers.  Often times, the prior authorization, or prior auth, is used to deny coverage for a drug or medical or surgical procedure if the provider has not requested and been granted the insurance company’s or pharmacy benefit manager (PBM) approval in advance.

The necessity of obtaining prior auth for many patients and many procedures and prescriptions is often cited by providers as among the factors weighing on their time that they might spend with patients, and patients are often frustrated by the time and delays they encounter.