§ 15-854. Prior authorization for prescription drugs
West's Annotated Code of MarylandInsuranceEffective: January 1, 2024
Effective: January 1, 2024
MD Code, Insurance, § 15-854
§ 15-854. Prior authorization for prescription drugs
(a)(1) This section applies to:
(b)(1)(i) If an entity subject to this section requires a prior authorization for a prescription drug, the prior authorization request shall allow a health care provider to indicate whether a prescription drug is to be used to treat a chronic condition.
(ii) If a health care provider indicates that the prescription drug is to treat a chronic condition, an entity subject to this section may not request a reauthorization for a repeat prescription for the prescription drug for 1 year or for the standard course of treatment for the chronic condition being treated, whichever is less.
(c) If an entity subject to this section denies coverage for a prescription drug, the entity shall provide a detailed written explanation for the denial of coverage, including whether the denial was based on a requirement for prior authorization.
(d)(1) On receipt of information documenting a prior authorization from the insured or from the insured's health care provider, an entity subject to this section shall honor a prior authorization granted to an insured from a previous entity for at least the initial 30 days of an insured's prescription drug benefit coverage under the health benefit plan of the new entity.
(e)(1) An entity subject to this section shall honor a prior authorization issued by the entity for a prescription drug:
(f) If an entity under this section implements a new prior authorization requirement for a prescription drug, the entity shall provide notice of the new requirement at least 30 days before the implementation of a new prior authorization requirement:
(g)(1) Except as provided in paragraph (2) of this subsection, an entity subject to this section may not require more than one prior authorization if two or more tablets of different dosage strengths of the same prescription drug are:
Credits
Added by Acts 2019, c. 549, § 1, eff. Jan. 1, 2020. Amended by Acts 2023, c. 364, § 1, eff. Jan. 1, 2024; Acts 2023, c. 365, § 1, eff. Jan. 1, 2024.
MD Code, Insurance, § 15-854, MD INSURANCE § 15-854
Current through legislation effective through June 1, 2024, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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