Sec. 45.2. Prior authorization form; prescription benefits.
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Sec. 45.2. Prior authorization form; prescription benefits.
(a)Notwithstanding any other provision of law, on and after January 1, 2015, a health insurer that provides prescription drug benefits must, within 72 hours after receipt of a paper or electronic prior authorization form from a prescribing provider or pharmacist, either approve or deny the prior authorization. In the case of a denial, the insurer shall provide the prescriber with the reason for the denial, an alternative covered medication, if applicable, and information regarding the denial.
In the case of an expedited coverage determination, the health insurer must either approve or deny the prior authorization within 24 hours after receipt of the paper or electronic prior authorization form. In the case of a denial, the health insurer shall provide the prescriber with the reason for the denial, an alternative covered medication, if applicable, and information regarding the procedure for submitting an appeal to the denial.
(b)This Section does not apply to plans for beneficiaries of Medicare or Medicaid.
(c)For the purposes of this Section:
"Pharmacist" has the same meaning as set forth in the Pharmacy Practice Act.
"Prescribing provider" includes a provider authorized to write a prescription, as described in subsection
(e)of Section 3 of the Pharmacy Practice Act, to treat a medical condition of an insured.