Legislation Updates

Electronic Prior Authorization Legislation Signed by New York Governor

Dec 12, 2016  |  Jessica Behrendsen

Great news, once again, from the state of New York. SB 4721A was signed by Governor Andrew Cuomo on November 14, calling for the use of electronic prior authorization (ePA).

This bill requires the Insurance Commission and Superintendent of Financial Services to develop standards for drug prior authorization (PA) and to take into consideration the NCPDP Standard. Once developed, health insurers would be required to follow the developed standards for ePA of medications.

New York has continuously been a state to watch in regards to legislation for health care IT. Their prescription monitoring program registry (ISTOP) and recent mandate for electronic prescribing (E-Prescribing) of controlled substances (EPCS), has made them a front-runner in the industry.

With the adoption of this new ePA legislation, streamlining the prior authorization process for all stakeholders and getting the patient their needed medication in a timely manner will be a benefit to all in New York.

Anytime legislation such as this is passed, it is vital to follow the guidelines set forth. The ISTOP program was designed to combat fraud, waste and abuse of controlled and non-controlled substances, and many of the drugs required for reporting in ISTOP also require PA before dispensing. The NCPDP Standards specified in SB 4721A support the efficiencies the State of New York is looking for through their health care IT initiatives by providing for expedited and real-time approval determinations for beneficiaries.

It’s also important to recognize that NCPDP has done a great job of providing a standard that meets the needs of the industry, which in turn is increasing awareness of the importance in passing this type of legislation.

For questions or additional information reach out to Kim Diehl-Boyd of our Government Affairs team at kdiehlboyd@covermymeds.com.

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