State Bills Aim To Standardize Some Rx Prior Authorization Processes
More than 20 states have pending legislation related to uniform prior authorization processes, such as requiring plans to accept a standardized, two-page form to be used by providers to request coverage, allowing electronic submission of the form and mandating that a plan must respond to a request for coverage within a certain number of days.
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Tactic aims to allow incoming Administration to scrutinize so-called ‘midnight rules’ issued in the final days of the Trump Administration before they take effect. Regulators may also solicit stakeholder comments on delayed rules.
The tactic aims to allow the new Biden administration to scrutinize so-called “midnight rules” issued in the final days of the Trump administration before they take effect. One reg targeted by the freeze is the recent SUNSET rule from the US HHS, which would require the department and its agencies – including the FDA – to review all regulations every 10 years to determine whether they’re still necessary.
Use of preferred and non-preferred specialty formulary tiers will be allowed but preferred tiers are not necessarily limited to generics and biosimilars and coinsurance for non-preferred specialty drugs cannot exceed 33%.