IL SB2585

Health insurers must utilize and accept a uniform prior authorization form for prescription drug benefits starting January 1, 2016; exempts Medicare and Medicaid plans.

The Department must develop the uniform form by July 1, 2015, with input from interested parties at a public meeting, considering federal Centers for Medicare and Medicaid Services forms and national electronic prior authorization standards.

Insurers must respond to prior authorization requests within 3 business days (or 24 hours for emergencies); if they fail to respond or accept the uniform form, the request is automatically deemed granted and paid at the insurer's indicated tier.

The uniform form cannot exceed 2 pages and must be electronically available through the Department and health insurers, with capability for electronic submission by prescribing providers and pharmacists.

"Pharmacist" and "prescribing provider" are defined according to the Pharmacy Practice Act.