Vote Smart's Synopsis:

Vote to pass a bill that prohibits prior authorization or step therapy which is when insurance companies and pharmacy benefit management companies refuse to cover a specific drug until after the patient has tried cheaper alternatives, for off-label medications or therapies for rare diseases in New Mexico.

Highlights:

• Prohibits prior authorization or step therapy in New Mexico (Sec. 1).

• Defines “prior authorization” as a voluntary or mandatory pre-service determination, including a recommended clinical review, that a health insurer makes regarding a covered person's eligibility for health care services, based on medical necessity, the appropriateness of the site of services and the terms of the covered person's health benefits plan (Sec. 1).

• Defines “step therapy” as when insurance companies and pharmacy benefit management companies refuse to cover a specific drug until after the patient has tried cheaper alternatives for off-label medications or therapies for rare diseases (Sec. 1).

• Defines “off-label” as a medication or a dosage of a medication that is not approved by the Federal Food and Drug Administration as a treatment for a specific condition or disease but is prescribed to a covered person because there is sufficient clinical evidence for a prescribing clinician to reasonably consider the medication to be medically necessary to treat the covered person's condition or disease (Sec. 1).

• Defines “Rare disease or condition” as a disease or condition that affects fewer than 200,000 people in the United States (Sec. 1).

• Specifies that the provisions of this bill shall take effect immediately upon passage and approval by the Governor (Sec. 4).

Full Bill Text

Vote Smart's Synopsis:

Vote to pass a bill that prohibits prior authorization or step therapy which is when insurance companies and pharmacy benefit management companies refuse to cover a specific drug until after the patient has tried cheaper alternatives, for off-label medications or therapies for rare diseases in New Mexico.

Highlights:

• Prohibits prior authorization or step therapy in New Mexico (Sec. 1).

• Defines “prior authorization” as a voluntary or mandatory pre-service determination, including a recommended clinical review, that a health insurer makes regarding a covered person's eligibility for health care services, based on medical necessity, the appropriateness of the site of services and the terms of the covered person's health benefits plan (Sec. 1).

• Defines “step therapy” as when insurance companies and pharmacy benefit management companies refuse to cover a specific drug until after the patient has tried cheaper alternatives for off-label medications or therapies for rare diseases (Sec. 1).

• Defines “off-label” as a medication or a dosage of a medication that is not approved by the Federal Food and Drug Administration as a treatment for a specific condition or disease but is prescribed to a covered person because there is sufficient clinical evidence for a prescribing clinician to reasonably consider the medication to be medically necessary to treat the covered person's condition or disease (Sec. 1).

• Defines “Rare disease or condition” as a disease or condition that affects fewer than 200,000 people in the United States (Sec. 1).

• Specifies that the provisions of this bill shall take effect immediately upon passage and approval by the Governor (Sec. 4).

Full Bill Text