Ohio Passes Prior Authorization Reform Act; Mandates Acceptance of ePA Solution

June 16, 2016  |  Jessica Behrendsen

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On Monday, Governor John Kasich of Ohio signed into law Senate Bill 129, the Prior Authorization Reform Act, which adopts the NCPDP SCRIPT Standard as the methodology for processing prescription prior authorizations (PA) and requires health plans to provide faster responses to medical and prescription coverage decisions.

CoverMyMeds was able to provide public testimony in favor of the bill stating the benefits of true electronic prior authorization (ePA), which was well received by House Committee members.

The bill was sponsored by Sen. Randy Gardner, R-Bowling Green and it states the following:

  • Health plans and pharmacy benefit managers (PBMs) shall accept prior authorization requests through a secure electronic transmission using the NCPDP SCRIPT Standard on any policies issued on or after Jan. 1, 2018.
  • Faxes are not considered secure electronic transmissions and proprietary payer portals are not considered secure transactions unless they use the NCPDP SCRIPT Standard.
  • Prescribers and health plans can enter into a contractual agreement foregoing this process if an undue hardship exists.
  • Health plans MUST respond within 48 hours for urgent care or 10 days for non-urgent requests.
  • If a PA is incomplete due to additional information being needed to complete the request, the prescriber shall provide additional information to the insurer within 72 hours of the request.
  • For polices issued on or after Jan. 1, 2017 and for chronic conditions, the health plan shall honor a PA approval for an approved drug for the lesser of 12 months or the last day of the covered person’s eligibility of the policy, contract or agreement.

The mandate is an incredible move in the right direction for the state of Ohio and the industry as a whole. Going forward we expect more states will see the benefits that ePA legislation offers key participants on every spoke of the wheel; most importantly the patients.

At CoverMyMeds, we pride ourselves on offering an ePA solution that reduces the risk of abandonment of the needed medication and ensures the patient begins or continues their needed medication therapy in a timely manner. For information on how our solution can assist in staying compliant with the aforementioned mandate, please visit our website at www.covermymeds.com.

If you have any questions about this regulation, feel free to reach out to Kim Diehl-Boyd of our Government Affairs team at kdiehlboyd@covermymeds.com.

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