New Mexico § 26-1-18.1 - Prescription drug prior authorization protocols

§ 26-1-18.1. Prescription drug prior authorization protocols

A. After January 1, 2014, a prescribing practitioner seeking prior authorization from

a health insurer may use the uniform prior authorization form developed pursuant to

Sections 2 and 3 of this 2013 act. B. As used in this section: (1) “ health insurer ” means a health insurer; a nonprofit health service provider; a health maintenance

organization; a managed care organization; or a provider service organization. “Health insurer” does not include: (a) a person that delivers, issues for delivery or renews an individual policy intended

to supplement major medical group-type coverages such as medicare supplement, long-term

care, disability income, specified disease, accident-only, hospital indemnity or other

limited-benefit health insurance policy; (b) a physician or a physician group to which a health insurer has delegated financial

risk for prescription drugs and that does not use a prior authorization process for

prescription drugs; or (c) a health insurer or its affiliated providers if the health insurer owns and operates

its pharmacies and does not use a prior authorization process for prescription drugs;

and (2) “ prescribing practitioner ” means a person that is licensed or certified to prescribe and administer drugs that

are subject to the New Mexico Drug, Device and Cosmetic Act.