Sec. 1369.304. STANDARD FORM. (a) The commissioner by rule shall:
(1) prescribe a single, standard form for requesting prior authorization of prescription drug benefits;
(2) require a health benefit plan issuer or the agent of the health benefit plan issuer that manages or administers prescription drug benefits to use the form for any prior authorization of prescription drug benefits required by the plan;
(3) require that the department and a health benefit plan issuer or the agent of the health benefit plan issuer that manages or administers prescription drug benefits make the form available electronically on the website of:
(A) the department;
(B) the health benefit plan issuer; and
(C) the agent of the health benefit plan issuer; and
(4) establish penalties for failure to accept the form and acknowledge receipt of the form as required by commissioner rule.
(b) Not later than the second anniversary of the date national standards for electronic prior authorization of benefits are adopted, a health benefit plan issuer or the agent of the health benefit plan issuer that manages or administers prescription drug benefits shall exchange prior authorization requests electronically with a prescribing provider who has e-prescribing capability and who initiates a request electronically.
(c) In prescribing a form under this section, the commissioner shall:
(1) develop the form with input from the advisory committee on uniform prior authorization forms established under Section 1369.305; and
(2) take into consideration:
(A) any form for requesting prior authorization of benefits that is widely used in this state or any form currently used by the department;
(B) request forms for prior authorization of benefits established by the federal Centers for Medicare and Medicaid Services; and
(C) national standards, or draft standards, pertaining to electronic prior authorization of benefits.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1328 (S.B. 644), Sec. 1, eff. September 1, 2013.
Redesignated from Insurance Code, Section 1369.254 by Acts 2015, 84th Leg., R.S., Ch. 1236 (S.B. 1296), Sec. 21.001(38), eff. September 1, 2015.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1236 (S.B. 1296), Sec. 21.002(15), eff. September 1, 2015.
Section: Previous 1369.267 1369.268 1369.269 1369.270 1369.301 1369.302 1369.303 1369.304 1369.305 1369.306 1369.351 1369.352 1369.353 1369.354 1369.355 NextLast modified: September 28, 2016