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SENATE BILL 477
57TH LEGISLATURE - STATE OF NEW MEXICO - FIRST SESSION, 2025
INTRODUCED BY
Martin Hickey
AN ACT
RELATING TO INSURANCE; ELIMINATING PRIOR AUTHORIZATION OR
PROHIBITING STEP THERAPY REQUIREMENTS FOR PRESCRIPTION DRUGS
USED TO PREVENT OR TREAT CERTAIN CONDITIONS.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. Section 59A-22B-8 NMSA 1978 (being Laws 2023,
Chapter 114, Section 13, as amended) is amended to read:
"59A-22B-8. PRIOR AUTHORIZATION FOR PRESCRIPTION DRUGS OR
STEP THERAPY FOR CERTAIN CONDITIONS PROHIBITED.--
A. Coverage for medication approved by the federal
food and drug administration that is prescribed for the
treatment or prevention of an autoimmune disorder, cancer, a
cholesterol disorder or a substance use disorder [pursuant to a
medical necessity determination ] shall not be subject to prior
authorization, except in cases in which a biosimilar,
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interchangeable biologic or generic version is available.
B. Coverage for medication approved by the federal
food and drug administration in the following drug classes
shall not be subject to prior authorization, except in cases in
which a biosimilar, interchangeable biologic or generic version
is available:
(1) glucagon-like peptide-1 agonists;
(2) glucose-dependent insulinotropic
polypeptide; or
(3) glucagon-like peptide-1 receptor agonists.
[B.] C. A health insurer shall not impose step
therapy requirements before authorizing coverage for medication
approved by the federal food and drug administration that is
prescribed for the treatment or prevention of an autoimmune
disorder, cancer, a cholesterol disorder or a substance use
disorder, pursuant to a medical necessity determination, except
in cases in which a biosimilar, interchangeable biologic or
generic version is available.
D. A health insurer shall not impose step therapy
requirements before authorizing coverage for medication
approved by the federal food and drug administration in the
following drug classes, except in cases in which a biosimilar,
interchangeable biologic or generic version is available:
(1) glucagon-like peptide-1 agonists;
(2) glucose-dependent insulinotropic
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polypeptide; or
(3) glucagon-like peptide-1 receptor
agonists."
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