SC H4562

Exempts healthcare providers from prior authorization requirements for specific services if they received approval on 80% or more of their prior authorization requests during the previous 12-month period

Establishes strict timelines for prior authorization decisions: 48 hours for non-urgent care and 24 hours for urgent care after all necessary information is received

Prohibits health carriers from removing prescription drugs from coverage, reclassifying drugs to higher cost tiers, or increasing patient cost-sharing during a policy year (with limited exceptions for safety concerns or generic availability)

Requires health carriers to honor prior authorizations for at least 60 days when a patient changes insurance plans, and prohibits ongoing prior authorization requirements for chronic condition treatments once initially authorized

Mandates annual transparency reporting to the Department of Insurance on prior authorization approval/denial rates, appeals outcomes, and step therapy exceptions, with the act taking effect for plans issued or renewed on or after January 1, 2027