§ 23-99-1117 — Standardized form required for prescription drug benefits

(a) On and after January 1, 2017, to establish uniformity in the submission of prior authorization forms for prescription drugs, a utilization review entity shall utilize only a single standardized prior authorization form for obtaining approval in written or electronic form for prescription drug benefits. (b) A utilization review entity may make the form required under subsection (a) of this section accessible through multiple computer operating systems. (c) The form required under subsection (a) of this section shall: (1) Not exceed two (2) pages; and (2) Be designed to be submitted electronically from a prescribing provider to a utilization review entity. (d) This section does not prohibit prior authorization by verbal means without a form. (e) If a utilization review entity fails to use or accept the form developed under this section or fails to respond as soon as reasonably possible, but no later than seventy-two (72) hours, after receipt of a completed prior authorization request using the form developed under this section, the prior authorization request is deemed authorized or approved. (f) (1) On and after January 1, 2017, each utilization review entity shall submit its prior authorization form to the State Insurance Department to be kept on file. (2) A copy of a subsequent replacement or modification of a utilization review entity's prior authorization form shall be filed with the department within fifteen (15) days before the form is used or before implementation of the replacement or modification.

Legislative History

Added by Act 2017, No. 815,§ 12, eff. 8/1/2017.