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Sent: Monday, September 22, 2014
Today's CMA Alert is an article on the implementation of SB 866
(Hernandez - 2011). The new law is intended to streamline and
standardize the prior authorization process for prescription drugs.
It will require all insurers, health plans (and their contracting
medical groups/IPAs) and providers to use a standardized two-page
form for prior authorizations of prescription medications.
The law also requires plans and insurers to make a determination
on prescription drug prior authorization requests within two days
of receipt, and if they fail to do so the requests will be deemed
authorized. Currently, payors are allowed five business days to
approve a prior auth for prescription drugs. The new law does not
expand the list of medications that require a prior
Unfortunately, the DMHC and DOI are implementing on different
dates. To prevent unnecessary rejections, duplicative
administrative work and delays in patient access to necessary
mediations, it is important that practices are aware of the new
requirement, which products are affected and when.
You can review the article
online. The article also includes a link to a new members' only
resource titled, "A
Physician's Guide to Implementation of SB 866: The new standardized
prescription drug prior authorization form," which includes a
Q&A on the topic.
Senior Director, CMA
1201 J St. #200
Sacramento , CA 95814