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CMA Alert: Implementation of SB 866

CMA Alert: Implementation of SB 866

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 authorization.

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.

Jodi Black
Senior Director, CMA
1201 J St. #200
Sacramento , CA 95814
Ph: 916/551-2863
Fx: 916/596-1130
jblack@cmanet.org