Standardized Prior Authorization Form for Prescription Medications Becomes Effective October 1 September 2, 2014 Physician Resource, Practice Management Form No. 61-211, SB 866, standardized prior authorization form 0 A new law (SB 866) will take effect in October 2014 that streamlines and standardizes the prior authorization process for prescription drugs. The new law requires all insurers, health plans (and their contracting medical groups/IPAs), and providers to use a standardized two-page form when requesting prior authorization for prescription drug benefits. Additionally, if a health plan or insurer fails to use or accept the prior authorization form, or fails to make a determination within two business days, the prior authorization request is deemed approved. Currently, plans have five business days in which to make a determination, while practices are often forced to sort through hundreds of different prior authorization forms to locate the one needed. Prescribing physicians must submit (and plans and insurers must accept) the new standardized two-page form for medications where a prior authorization is required. However, the standardized form does not apply to requests for authorization of procedures or expand the list of medications that require a prior authorization. The Department of Managed Health Care (DMHC) and the Department of Insurance (DOI) jointly developed the standardized authorization form and implementing regulations with stakeholder input. The two agencies, however, will be enforcing the regulations on different timetables. The regulation for DMHC-regulated products, which includes all HMOs, their contracting medical groups/IPAs, and most Blue Cross and Blue Shield PPOs, becomes effective January 1, 2015. However, the regulation for DOI-regulated products, including all other PPOs and the Blue Cross and Blue Shield Life & Health products, becomes effective on October 1, 2014. The form (No. 61-211) will be available on the plan and insurer websites as well as the regulators’ websites soon, and can be submitted via paper, electronic transmission, telephone, web portal or another mutually agreeable method. Click here for more information on SB 866. Comments are closed.
