HB24-1149 Summary

• Requires carriers and organizations to post current prior authorization requirements and restrictions in standardized, searchable, readily accessible format on public-facing websites starting January 1, 2026.

• Mandates carriers and pharmacy benefit managers adopt programs by January 1, 2026 that eliminate or substantially modify prior authorization requirements for qualified providers meeting objective criteria related to quality, appropriateness, and specialty experience.

• Requires carriers and organizations to implement prior authorization application programming interfaces (APIs) by January 1, 2027 that comply with federal standards and enable electronic submission and response to requests.

• Establishes that prior authorizations are valid for a calendar year (not 180 days) and limits reauthorization of previously approved chronic maintenance drugs to once every three years unless specific exceptions apply.

• Appropriates $36,514 to the Division of Insurance for 2024-25 to implement the act, effective January 1, 2026.