New Standardized Prior Authorization Form for Prescription Medications Becomes Effective October 1

Sep 19, 2014 - Oct 01, 2014


CPMA backed bill SB 866 that streamlines and standardizes the prior authorization process for prescription drugs will take effect October 1. The new law requires all insurers, health plans (and their contracting medical groups/IPAs) and providers to use a standardized two-page form for prior authorizations of prescription medications.

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.

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