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New Mexico Statutes Chapter 26. Drugs and Cosmetics § 26-1-18.1. Prescription drug prior authorization protocols

Current as of January 01, 2024 | Updated by Findlaw Staff

A. After January 1, 2014, a prescribing practitioner seeking prior authorization from a health insurer may use the uniform prior authorization form developed pursuant to Sections 2 and 3 of this 2013 act.

B. As used in this section:

(1) “health insurer” means a health insurer; a nonprofit health service provider; a health maintenance organization; a managed care organization; or a provider service organization. “Health insurer” does not include:

(a) a person that delivers, issues for delivery or renews an individual policy intended to supplement major medical group-type coverages such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or other limited-benefit health insurance policy;

(b) a physician or a physician group to which a health insurer has delegated financial risk for prescription drugs and that does not use a prior authorization process for prescription drugs; or

(c) a health insurer or its affiliated providers if the health insurer owns and operates its pharmacies and does not use a prior authorization process for prescription drugs; and

(2) “prescribing practitioner” means a person that is licensed or certified to prescribe and administer drugs that are subject to the New Mexico Drug, Device and Cosmetic Act.

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Cite this article: FindLaw.com - New Mexico Statutes Chapter 26. Drugs and Cosmetics § 26-1-18.1. Prescription drug prior authorization protocols - last updated January 01, 2024 | https://codes.findlaw.com/nm/chapter-26-drugs-and-cosmetics/nm-st-sect-26-1-18-1/

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