HB 273 Summary

• Creates the Ensuring Appropriate Access to Medicines for Premature Infants Act requiring the Alabama Medicaid Agency to develop policies streamlining prior authorization for covered outpatient drugs for premature infants (those born before 37 weeks gestation and under one year old).

• Requires the Medicaid Agency to respond to prior authorization requests within 24 hours with approval or denial decision; requests not adjudicated within 24 hours are deemed approved as submitted.

• Mandates transparency by posting all prior authorization requirements, forms, and appeals processes on the Medicaid Agency's website for physicians, parents, and caregivers.

• Establishes an effective appeals process allowing patients to receive continued coverage pending appeal outcomes and includes consumer protections from the Uniform External Review Model Act.

• Requires the Medicaid Agency to annually monitor and report health outcomes (hospital readmissions, emergency visits) for premature infants denied prescription drugs and develop standards ensuring timely access to care applicable to all Medicaid programs in the state.