SLS 18RS-121 REENGROSSED
2018 Regular Session
SENATE BILL NO. 29
BY SENATOR MILLS
HEALTH SERVICES. Provides relative to a single uniform prescription drug prior
authorization form. (1/1/19)
1 AN ACT
2 To amend and reenact R.S. 22:1006.1(A)(4) and (B) and R.S. 46:460.33 and to enact R.S.
3 22:1006.1(C), (D), and (E), relative to a single uniform prescription drug prior
4 authorization form; to provide for applicability to health insurance issuers and
5 Medicaid managed care organizations; to provide for promulgation of the form by
6 the Louisiana Board of Pharmacy and the Louisiana State Board of Medical
7 Examiners; to provide for the authority to impose sanctions pursuant to current
8 regulatory and contract authority; to provide for an effective date; and to provide for
9 related matters.
10 Be it enacted by the Legislature of Louisiana:
11 Section 1. R.S. 22:1006.1(A)(4) and (B) are hereby amended and reenacted and R.S.
12 22:1006.1(C), (D), and (E) are hereby enacted to read as follows:
13 §1006.1. Prior authorization forms required; criteria
14 A. As used in this Section:
15 * * *
16 (4) "Prior authorization form" shall mean a standardized, uniform application
17 developed by a health insurance issuer single uniform prescription drug prior
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 29
SLS 18RS-121 REENGROSSED
1 authorization form used by all health insurance issuers, including any health
2 insurance issuer pharmacy benefit managers, for the purpose of obtaining prior
3 authorization.
4 B. Notwithstanding any other provision of law to the contrary, in order to
5 establish uniformity in the submission of prescription drug prior authorization
6 forms, on and after January 1, 2013 2019, a health insurance issuer shall utilize only
7 a single, standardized prior authorization uniform prescription drug prior
8 authorization form for obtaining any prior authorization for prescription drug
9 benefits. The requirement for a single uniform prescription drug prior
10 authorization form shall not apply to prior authorization of specialty drugs or
11 in cases where electronic prescriptions are utilized. The form shall not exceed two
12 pages in length, excluding any instructions or guiding documentation. The only
13 form allowable for use shall be the form jointly promulgated by the Louisiana
14 Board of Pharmacy and the Louisiana State Board of Medical Examiners. A
15 health insurance issuer may include issuer specific information on the form,
16 including but not limited to the issuer's name, address, logo, and other contact
17 information for the issuer. A health insurance issuer may make the form accessible
18 through multiple computer operating systems. Additionally, the health insurance
19 issuer shall submit its prior authorization forms to the Department of Insurance to be
20 kept on file on or after January 1, 2013. A copy of any subsequent replacements or
21 modifications of a health insurance issuer's prior authorization form shall be filed
22 with the Department of Insurance within fifteen days prior to use or implementation
23 of such replacements or modifications.
24 C. The Louisiana Board of Pharmacy and the Louisiana State Board of
25 Medical Examiners shall promulgate rules and regulations prior to January 1,
26 2019, that establish the form that shall be utilized by all health insurance
27 issuers. The boards may consult with the health insurance issuers, Medicaid
28 managed care organizations, Louisiana Department of Health, and Department
29 of Insurance as necessary in development of the prior authorization form.
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SLS 18RS-121 REENGROSSED
1 D. The Department of Insurance, under its authority in this Title, shall
2 assess sanctions against any health insurance issuer that directly, or through its
3 pharmacy benefit managers, utilizes any prescription drug prior authorization
4 form other than the single uniform prescription drug prior authorization form
5 provided for in this Section.
6 E. The single uniform prescription drug prior authorization form
7 provided for in this Section shall be the same as provided for in R.S. 46:460.33.
8 Section 2. R.S. 46:460.33 is hereby amended and reenacted to read as follows:
9 §460.33. Prior authorization form; requirements
10 A. There shall be a single uniform prescription drug prior authorization
11 form used by all Medicaid managed care organizations, including any Medicaid
12 managed care organization pharmacy benefit managers. The requirement for
13 a single uniform prescription drug prior authorization form shall not apply to
14 prior authorization of specialty drugs or in cases where electronic prescriptions
15 are utilized. All managed care organizations shall accept, in addition to any
16 currently accepted facsimile and electronic prior authorization forms, a standard use
17 a single uniform prescription drug prior authorization form, not to exceed two
18 pages, excluding guidelines or instructions, that has been duly jointly promulgated
19 by the department Louisiana Board of Pharmacy and the Louisiana State Board
20 of Medical Examiners in accordance with the Administrative Procedure Act. A
21 Medicaid managed care organization may include organization specific
22 information on the form, including but not limited to the organization's name,
23 address, logo, and other contact information for the organization. A health care
24 provider may submit the prior authorization form electronically if the Medicaid
25 managed care organization allows for submission of the form in this manner.
26 B. The department Louisiana Board of Pharmacy and the Louisiana State
27 Board of Medical Examiners shall promulgate rules and regulations prior to
28 January 1, 2014 2019, that establish the form which shall be utilized by all Medicaid
29 managed care organizations. The department boards may consult with the health
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Coding: Words which are struck through are deletions from existing law;
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SLS 18RS-121 REENGROSSED
1 insurance issuers, Medicaid managed care organizations, Louisiana Department
2 of Health, and Department of Insurance as necessary in development of the prior
3 authorization form.
4 C. Pursuant to its contract with any Medicaid managed care
5 organization, the department shall assess sanctions against any Medicaid
6 managed care organization that directly or through its pharmacy benefit
7 managers, utilizes any prescription drug prior authorization form other than
8 the single uniform prescription drug prior authorization form provided for in
9 this Section.
10 D. The single uniform prescription drug prior authorization form
11 provided for in this Section shall be the same as provided for in R.S. 22:1006.1.
12 Section 3. This Act shall become effective on January 1, 2019.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Christine Arbo Peck.
DIGEST
SB 29 Reengrossed 2018 Regular Session Mills
Present law requires individual health insurance issuers licensed by the Department of
Insurance to use a standardized prescription drug prior authorization form. The form must
be submitted to the Department of Insurance and kept on file with their office.
Present law requires Medicaid managed care organizations that contract with the Louisiana
Department of Health to use a standard form, in addition to other forms, for prescription
drug prior authorization.
Proposed law requires the Louisiana Board of Pharmacy and the Louisiana State Board of
Medical Examiners to develop a single uniform prescription drug prior authorization form
for all health insurance issuers, Medicaid managed care organizations, and their respective
pharmacy benefit managers. Proposed law provides that the single uniform prescription drug
prior authorization form does not apply to specialty drugs or in cases where electronic
prescriptions are utilized.
Proposed law provides that the Louisiana Board of Pharmacy and the Louisiana State Board
of Medical Examiners may consult with the health insurance issuers, Medicaid managed care
organizations, Louisiana Department of Health, and Department of Insurance as necessary
in developing the form.
Proposed law authorizes the Department of Insurance, under their regulatory authority in
Title 22 and the Department of Health pursuant to its contracts with Medicaid managed care
organizations to impose sanctions for failure to comply with the requirement of using only
the single uniform prescription drug prior authorization form.
Proposed law implements use of the single uniform prescription drug prior authorization
form on and after January 1, 2019.
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 29
SLS 18RS-121 REENGROSSED
Effective January 1, 2019.
(Amends R.S. 22:1006.1(A)(4) and (B) and R.S. 46:460.33; adds R.S. 22:1006.1(C), (D),
and (E))
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Health and Welfare to
the original bill
1. Provides that the single uniform prescription drug prior authorization form
does not apply to prior authorization of specialty drugs or in cases where
electronic prescriptions are utilized.
2. Provides that the Louisiana Board of Pharmacy and the Louisiana State
Board of Medical Examiners may consult with the health insurance issuers,
Medicaid managed care organizations, Louisiana Department of Health, and
Department of Insurance as necessary in developing the form.
3. Clarifies that the provisions of R.S. 46:460.33 apply to Medicaid managed
care organizations.
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.