MO HB2186

Requires all pharmacy benefit managers and health insurers offering pharmaceutical coverage in Missouri to provide a single standardized one-page prior authorization form for providers to submit written requests.

The standardized form must include patient information, prescriber details (name, NPI number, contact information), diagnosis, ICD code, drug description and strength, quantity, day supply, prior medication trials, prescriber signature, request date, office contact information, and health insurer/pharmacy benefit manager contact numbers.

Health insurers and pharmacy benefit managers must accept all completed prior authorization forms submitted by providers and respond within 72 hours, or notify the provider and patient within 72 hours if unable to authorize or decline with a phone number for obtaining additional information.

Prior authorization is automatically deemed granted if the health insurer or pharmacy benefit manager fails to use or accept the standardized form or fails to respond within 72 hours of receiving a completed request.

Applies to all health insurers and pharmacy benefit managers offering or providing pharmaceutical coverage in Missouri.