Bill > SB39

This bill amends New Mexico's Prior Authorization Act to expand protections for patients seeking medication for specific medical conditions. The legislation prohibits health insurers from requiring prior authorization or step therapy (a process where patients must try less expensive medications before accessing prescribed treatments) for medications treating autoimmune disorders, cancer, rare diseases, and substance use disorders, except when a generic, biosimilar, or interchangeable biologic version is available. The bill mandates that medical necessity determinations for these conditions must be automatically approved within seven days for standard cases and within 24 hours for emergencies where treatment delay could seriously jeopardize a patient's health, impair their ability to regain maximum function, or subject them to severe pain. Additionally, the bill requires health insurers to maintain an electronic portal for prior authorization requests, provide electronic receipts with tracking numbers, and establish processes for appeals and review of prior authorization practices. These provisions will apply to individual and group health insurance policies issued on or after July 1, 2025, and aim to streamline access to necessary medications and reduce administrative barriers for patients with complex medical conditions.

Budget and Finance, Health and Social Services

https://www.nmlegis.gov/Legislation/Legislation?chamber=S&legtype=B&legno=39&year=25