Common use of Prescription drug Prior Authorization protocols Clause in Contracts

Prescription drug Prior Authorization protocols. After January 1, 2014, a health care plan shall accept the uniform Prior Authorization form developed pursuant to Sections 2 [59A-2-9.8 NMSA 1978] and 3 [61-11-6.2 NMSA 1978] of this 2013 act as sufficient to request Prior Authorization for prescription drug benefits. No later than twenty-four months after the adoption of national standards for electronic prior authorization, a health insurer shall exchange prior authorization requests with providers who have e-prescribing capability. If a health care plan fails to use or accept the uniform Prior Authorization form or fails to respond within three business days upon receipt of a uniform Prior Authorization form, the Prior Authorization request shall be deemed to have been granted. As used in this section, "health care plan" means a nonprofit corporation authorized by the superintendent to enter into contracts with subscribers and to make health care expense payments but does not include: A person that only issues a limited-benefit policy intended to supplement major medical coverage, including Medicare supplement, vision, dental, disease-specific, accident-only or hospital indemnity-only insurance policies, or that only issues policies for long-term care or disability income; A physician or a physician group to which a health care plan has delegated financial risk for prescription drugs and that does not use a Prior Authorization process for prescription drugs; or A health care plan or its affiliated providers, if the health care plan owns and operates its pharmacies and does not use a Prior Authorization process.

Prescription drug Prior Authorization protocols. After January 1, 2014, a health care plan shall accept the uniform Prior Authorization form developed pursuant to Sections 2 [59A-2-9.8 NMSA 1978] and 3 [61-11-6.2 NMSA 1978] of this 2013 act as sufficient to request Prior Authorization for prescription drug benefits. No later than twenty-four months after the adoption of national standards for electronic prior authorization, a health insurer shall exchange prior authorization Prior Authorization requests with providers who have e-prescribing capability. If a health care plan fails to use or accept the uniform Prior Authorization form or fails to respond within three business days upon receipt of a uniform Prior Authorization form, the Prior Authorization request shall be deemed to have been granted. As used in this section, "health care plan" means a nonprofit corporation authorized by the superintendent to enter into contracts with subscribers and to make health care expense payments but does not include: A person that only issues a limited-benefit policy intended to supplement major medical coverage, including Medicare supplement, vision, dental, disease-specific, accident-only or hospital indemnity-only insurance policies, or that only issues policies for long-term care or disability income; A physician or a physician group to which a health care plan has delegated financial risk for prescription drugs and that does not use a Prior Authorization process for prescription drugs; or A health care plan or its affiliated providers, providers if the health care plan owns and operates its pharmacies and does not use a Prior Authorization process.

Prescription drug Prior Authorization protocols. After January 1, 2014, a health care plan shall accept the uniform Prior Authorization prior authorization form developed pursuant to Sections 2 [59A-2-9.8 NMSA 1978] and 3 [61-11-6.2 NMSA 1978] of this 2013 act as sufficient to request Prior Authorization prior authorization for prescription drug benefits. No later than twenty-four months after the adoption of national standards for electronic prior authorization, a health insurer shall exchange prior authorization requests with providers who have e-prescribing capability. If a health care plan fails to use or accept the uniform Prior Authorization prior authorization form or fails to respond within three business days upon receipt of a uniform Prior Authorization prior authorization form, the Prior Authorization prior authorization request shall be deemed to have been granted. As used in this section, "health care plan" means a nonprofit corporation authorized by the superintendent to enter into contracts with subscribers and to make health care expense payments but does not include: A • a person that only issues a limited-benefit policy intended to supplement major medical coverage, including Medicare supplement, vision, dental, disease-specific, accident-only or hospital indemnity-only insurance policies, or that only issues policies for long-term care or disability income; A • a physician or a physician group to which a health care plan has delegated financial risk for prescription drugs and that does not use a Prior Authorization prior authorization process for prescription drugs; or A • a health care plan or its affiliated providers, if the health care plan owns and operates its pharmacies and does not use a Prior Authorization prior authorization process. Benefits‌‌ This Healthcare Benefit Plan offers Coverage for a wide range of Healthcare Services. This Section gives you the details about your benefits, and other requirements, Limitations and Exclusions.

Prescription drug Prior Authorization protocols. After January 1, 2014, a health care plan shall accept the uniform Prior Authorization form developed pursuant to Sections 2 [59A-2-9.8 NMSA 1978] and 3 [61-11-6.2 NMSA 1978] of this 2013 act as sufficient to request Prior Authorization for prescription drug benefits. No later than twenty-four months after the adoption of national standards for electronic prior authorization, a health insurer shall exchange prior authorization Prior Authorization requests with providers who have e-prescribing capability. If a health care plan fails to use or accept the uniform Prior Authorization form or fails to respond within three business days upon receipt of a uniform Prior Authorization form, the Prior Authorization request shall be deemed to have been granted. As used in this section, "health care plan" means a nonprofit corporation authorized by the superintendent to enter into contracts with subscribers and to make health care expense payments but does not include: A person that only issues a limited-benefit policy intended to supplement major medical coverage, including Medicare supplement, vision, dental, disease-specific, accident-only or hospital indemnity-only insurance policies, or that only issues policies for long-term care or disability income; A physician or a physician group to which a health care plan has delegated financial risk for prescription drugs and that does not use a Prior Authorization process for prescription drugs; or A health care plan or its affiliated providers, if the health care plan owns and operates its pharmacies and does not use a Prior Authorization process.