SB196 Summary

• Creates the "Ensuring Appropriate Access to Medicines for Premature Infants Act" requiring Alabama Medicaid Agency to streamline prior authorization processes for covered outpatient drugs for premature infants (defined as infants under one year of age born at less than 37 weeks gestation).

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

• Requires prior authorizations to be submittable electronically, via facsimile, or by telephone, and establishes an effective appeals process allowing patients to receive continued coverage while appeals are pending.

• Obligates Medicaid Agency to post all prior authorization requirements, forms, and appeals processes on its public website and ensure prescribed medicines are given at minimum dosages and duration as specified in FDA prescribing information.

• Requires annual data collection and legislative reporting on health outcomes (hospital readmissions, emergency visits, outpatient visits) for premature infants denied covered prescription drugs, with implementation deadline of July 1, 2012.