HB 1808 Summary: Ensuring Transparency in Prescription Drugs Prior Authorization Act

• Requires utilization review entities to make prior authorization requirements, clinical criteria, and formularies readily accessible on websites in easily understandable language, with 60 days' notice before implementing new or amended requirements.

• Mandates that adverse determinations be made by physicians, pharmacists, or licensed mental health professionals with appropriate training and valid unrestricted licenses, with appeals reviewers being uninvolved in the original determination and having no financial interest in the outcome.

• Establishes 24-hour decision timelines for urgent prescription drugs and 4 business days for non-urgent drugs; prescription drugs are automatically authorized if utilization review entities fail to meet deadlines when providers submit through authorized systems.

• Extends prior authorization validity to 3 years for chronic condition treatments (except opioids and weight loss drugs), requires honoring prior authorizations from previous plans for 60 days, and continues coverage during product changes under the same health insurance company.

• Prohibits prior authorization requirements for prescription drugs administered as emergency health care services and establishes penalties of up to $5,000 per violation, enforceable by the Insurance Commissioner or Attorney General; effective November 1, 2025.