§ 26-55-111 — Continuity of care for enrollees

(a) On receipt of all necessary information documenting an
authorization from the enrollee, previous health insurer or the
enrollee's health care provider, a health insurer or contracted
utilization review entity shall honor an authorization granted
to an enrollee from a previous health insurer or contracted
utilization review entity for not less than ninety (90) days
after an enrollee's coverage under a new health plan commences,
if the health care service is a covered benefit under the new
health insurance plan.
(b) During the time period described in subsection (a) of
this section, a health insurer or contracted utilization review
entity may perform its own review to grant a new authorization.
(c) If there is a change in coverage of, or a change in
approval criteria for, a previously authorized health care
service under the enrollee's current health care plan, the
change in coverage or approval criteria shall not affect an
enrollee who received authorization less than one (1) year
before the effective date of the change. A health insurer or
contracted utilization review entity may require a new prior
authorization request one (1) year after the enrollee's previous
prior authorization was requested.
(d) No enrollee shall be required to repeat a step therapy
protocol if that enrollee, while under their current or a
previous health benefit plan, used the prescription drug
required by the step therapy protocol, or another prescription
drug in the same pharmacologic class with a similar efficacy and
side effect profile or with the same mechanism of action, and
discontinued use due to lack of efficacy, effectiveness, an
adverse event or contraindication. The enrollee's prescribing
provider shall submit justification and clinical information, if
requested, that demonstrates a clinically valid reason for why
the covered prescribed drug is needed and documentation of
completion of previous step therapy protocols for the prescribed
drug.