§ 59a-22b-8

A. Coverage for medication approved by the federal food and drug administration that is prescribed for the treatment of an autoimmune disorder, cancer or a substance use disorder, pursuant to a medical necessity determination, shall not be subject to prior authorization, except in cases in which a biosimilar, interchangeable biologic or generic version is available.B. A health insurer shall not impose step therapy requirements before authorizing coverage for medication approved by the federal food and drug administration that is prescribed for the treatment of an autoimmune disorder, cancer or a substance use disorder, pursuant to a medical necessity determination, except in cases in which a biosimilar, interchangeable biologic or generic version is available.History: Laws 2023, ch. 114, § 13; 2024, ch. 42, § 4. ANNOTATIONSThe 2024 amendment, effective May 15, 2024, added autoimmune disorders and cancer to an existing provision for which prior authorization for certain prescription drugs is not required, except in cases in which a biosimilar, interchangeable biologic or a generic version is available, and added autoimmune disorder and cancer to an existing provision for which step

gs is not required, except in cases in which a biosimilar, interchangeable biologic or a generic version is available, and added autoimmune disorder and cancer to an existing provision for which step therapy requirements shall not be imposed, except in cases in which a biosimilar, interchangeable biologic or generic version is available; in Subsection A, after 'for the treatment of', added 'an autoimmune disorder, cancer or', and added 'biosimilar, interchangeable biologic or' preceding 'generic'; and in Subsection B, after 'for the treatment of', added 'an autoimmune disorder, cancer or', and added 'biosimilar, interchangeable biologic or' preceding 'generic'.Applicability. — Laws 2024, ch. 42, § 7 provided that the provisions of Sections 1 and 3 through 6 [13-7-18, 59A-22-53.1, 59A-22B-8, 59A-46-52.1, 59A-47-47.1 NMSA 1978] of this act do not apply to short-term plans subject to the Short-Term Health Plan and Excepted Benefit Act [Chapter 59A, Article 23G NMSA 1978].Laws 2024, ch. 42, § 8 provided that the provisions of Laws 2024, ch. 42 apply to group health insurance policies, health care plans or certificates of health insurance, other than small group health plans, that are

2, § 8 provided that the provisions of Laws 2024, ch. 42 apply to group health insurance policies, health care plans or certificates of health insurance, other than small group health plans, that are delivered, issued for delivery or renewed in this state on or after January 1, 2025.Laws 2023, ch. 114, § 46 provided that the provisions of Laws 2023, ch. 114 are applicable to group health insurance policies, health care plans or certificates of health insurance, other than small group health plans, that are delivered, issued for delivery or renewed in this state on or after January 1, 2024.