§1006.1. Prior authorization forms required; criteria
A. As used in this Section:
(1)"Health benefit plan", "plan", "benefit", or "health insurance coverage" means
services consisting of medical care, provided directly, through insurance or reimbursement,
or otherwise, and including items and services paid for as medical care under any hospital
or medical service policy or certificate, hospital or medical service plan contract, preferred
provider organization, or health maintenance organization contract offered by a health
insurance issuer. However, excepted benefits are not included as a "health benefit plan".
(2)"Health insurance issuer" means any entity that offers health insurance coverage
through a plan, policy, or certificate of insurance subject to state law that regulates the
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§1006.1. Prior authorization forms required; criteria
A. As used in this Section:
(1) "Health benefit plan", "plan", "benefit", or "health insurance coverage" means
services consisting of medical care, provided directly, through insurance or reimbursement,
or otherwise, and including items and services paid for as medical care under any hospital
or medical service policy or certificate, hospital or medical service plan contract, preferred
provider organization, or health maintenance organization contract offered by a health
insurance issuer. However, excepted benefits are not included as a "health benefit plan".
(2) "Health insurance issuer" means any entity that offers health insurance coverage
through a plan, policy, or certificate of insurance subject to state law that regulates the
business of insurance. "Health insurance issuer" shall also include a health maintenance
organization, as defined and licensed pursuant to Subpart I of Part I of Chapter 2 of this Title.
(3) "Prior authorization" shall mean a utilization management criterion utilized to
seek permission or waiver of a drug to be covered under a health benefit plan that provides
prescription drug benefits.
(4) "Prior authorization form" shall mean a single uniform prescription drug prior
authorization form used by all health insurance issuers, including any health insurance issuer
pharmacy benefit managers, for the purpose of obtaining prior authorization.
B. Notwithstanding any other provision of law to the contrary, in order to establish
uniformity in the submission of prescription drug prior authorization forms, on and after
January 1, 2019, a health insurance issuer shall utilize only a single uniform prescription drug
prior authorization form for obtaining any prior authorization for prescription drug benefits.
The requirement for a single uniform prescription drug prior authorization form shall not
apply to prior authorization of specialty drugs or in cases where electronic prescriptions are
utilized. The form shall not exceed two pages in length, excluding any instructions or guiding
documentation. The only form allowable for use shall be the form jointly promulgated by the
Louisiana Board of Pharmacy and the Louisiana State Board of Medical Examiners. A health
insurance issuer may include issuer specific information on the form, including but not
limited to the issuer's name, address, logo, and other contact information for the issuer. A
health insurance issuer may make the form accessible through multiple computer operating
systems.
C. The Louisiana Board of Pharmacy and the Louisiana State Board of Medical
Examiners shall promulgate rules and regulations prior to January 1, 2019, that establish the
form that shall be utilized by all health insurance issuers. The boards may consult with the
health insurance issuers, Medicaid managed care organizations, Louisiana Department of
Health, and Department of Insurance as necessary in development of the prior authorization
form.
D. The Department of Insurance, under its authority in this Title, shall assess
sanctions against any health insurance issuer that directly, or through its pharmacy benefit
managers, utilizes any prescription drug prior authorization form other than the single
uniform prescription drug prior authorization form provided for in this Section.
E. The single uniform prescription drug prior authorization form provided for in this
Section shall be the same as provided for in R.S. 46:460.33.