SB3 Summary: Ensuring Appropriate Access to Medicines for Premature Infants Act

• Alabama Medicaid Agency must develop and implement policies by July 1, 2012 to streamline prior authorization processes for covered outpatient drugs for premature infants (infants under one year old born at less than 37 weeks gestation).

• Medicaid Agency must respond to prior authorization requests within 24 hours with an approval or denial decision including rationale, and requests not adjudicated within 24 hours are deemed approved as submitted.

• Agency must post all prior authorization requirements, forms, supporting materials, and appeals processes on its public website organized by therapeutic area or individual drug for physician and caregiver access.

• Medicaid Agency must implement an effective appeals process allowing patients to receive continued coverage pending appeal outcomes, with timely reviews and consumer protections consistent with the Uniform External Review Model Act.

• Agency must annually collect and report to the Legislature data on hospital readmissions, emergency visits, and outpatient visits for premature infants denied covered prescription drugs to identify policies detrimentally impacting patient health or access to care.