33-46-23.1. Prior authorization of prescription medications for chronic conditions.

As used in this Code section, the term:#

1. (1)

   “Chronic condition” means a serious, long-term, physical, mental, or developmental disability or disease.#

2. (2)

   “Ongoing medication therapy” means a clinical and evidencebased treatment that uses a prescribed medicine to prevent, diagnose, treat, or relieve the symptoms of a chronic condition and is continuing or expected to continue for at least a year.#

Unless otherwise provided in subsection (c) of this Code section or prohibited by state or federal law, if a healthcare provider receives a prior authorization for a medication prescribed to a covered person with a chronic condition that requires ongoing medication therapy, and the provider continues to prescribe the medication, and the medication is used for a condition that is within the scope of use approved by the United States Food and Drug Administration or has been proven to be a safe and effective form of treatment for the patient’s specific underlying condition based on clinical practice guidelines that are developed from peer-reviewed publications, the prior authorization received shall:#

1. (1)

   Be valid for the lesser of:#

   1. (A)

      One year from the date the healthcare provider receives the prior authorization; or#

   2. (B)

      Until the last day of coverage under the covered person’s healthcare plan; and#

2. (2)

   Cover any change in dosage prescribed by the healthcare provider during the period of authorization.#

1. (1)

   This Code section shall not apply to:#

   1. (A)

      Medications that are prescribed for a nonmaintenance condition;#

   2. (B)

      Medications that have a typical treatment period of less than 12 months;#

   3. (C)

      Medications for which medical or scientific evidence does not support a 12 month approval, including medications where an initial shorter duration approval is necessary to demonstrate appropriate response to therapy; or#

   4. (D)

      Medications that are opioid analgesics or benzodiazepines.#

2. (2)

   Nothing in this Code section prevents the prior authorization of a medication for more than a year if permissible by the covered person’s healthcare plan.#