SENATE BILL 207

57th legislature - STATE OF NEW MEXICO - first session, 2025

INTRODUCED BY

Elizabeth "Liz" Stefanics and Elizabeth "Liz" Thomson

and Martin Hickey and Reena Szczepanski

 

 

 

 

AN ACT

RELATING TO INSURANCE; AMENDING THE PRIOR AUTHORIZATION ACT TO ADD MORE CLASSES OF DRUGS THAT ARE NOT SUBJECT TO PRIOR AUTHORIZATIONS OR STEP THERAPY PROTOCOLS.

 

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 on-label or off-label use, for the treatment of an autoimmune disorder, cancer, a rare disease 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, interchangeable biologic or generic version is available.

          B. 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 on-label or off-label use, for the treatment of an autoimmune disorder, cancer, a rare disease 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.

          C. For the purposes of this section, "rare disease" means a disease or medical condition that affects fewer than two hundred thousand people in the United States."

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