SB 833
Excluding pharmaceutical medication from prior authorization gold card process
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- Passed Senate
- Passed House of Delegates
- To Governor
- Became Law
Bill overview
This bill aims to change how West Virginia handles prior authorizations for prescription medications. Currently, a ‘gold card’ process requires prior approval for certain medications. This bill seeks to exclude pharmaceutical medications from this process, meaning they won’t need prior authorization from the Bureau of Medical Services before being prescribed. The bill also updates the requirements for electronic submission of prior authorization requests and establishes a process for appealing denials.
Key provisions
- Excludes pharmaceutical medications from the prior authorization ‘gold card’ process.
- Requires prior authorization requests to be submitted electronically via a Bureau of Medical Services portal.
- Establishes a timeframe for the Bureau of Medical Services to respond to prior authorization requests (within 5 business days, with exceptions for urgent cases).
- Requires health maintenance organizations to also submit prior authorization requests electronically.
- Specifies a process for appealing denied prior authorizations, including peer-to-peer review.
- Allows for a temporary exemption from prior authorization requirements for certain healthcare providers with a high approval rate.
- Mandates quarterly data reporting by the Inspector General on prior authorization activity.
- Provides for civil penalties for violations of the bill’s provisions.
Who is affected
- Healthcare providers
- Patients
- Health Maintenance Organizations
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