SC S0531

Exempts healthcare providers from prior authorization requirements if they receive 90% or more approvals for a specific service, with annual reviews by health carriers

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

Prohibits health insurers from removing prescription drugs from formularies, moving drugs to higher cost tiers, or increasing patient cost-sharing during a policy year (with limited exceptions)

Eliminates ongoing prior authorization requirements for chronic condition treatments once initial authorization is granted, and requires new insurers to honor prior authorizations from previous carriers for at least 60 days

Requires health carriers to report annually to the Department of Insurance on prior authorization approval/denial rates, appeals outcomes, and step therapy exception requests, with data made publicly available online