1. A. The office shall standardize and streamline the prior authorization process across all health insurers.
2. B. On or before September 1, 2019, the office shall, in collaboration with health insurers and health care providers, promulgate a uniform prior authorization form for medical care, pharmaceutical benefits or related benefits to be used by every health insurer and health care provider after January 1, 2020; provided that the uniform prior authorization form shall conform to the requirements established for medicare and medicaid medical and pharmacy prior authorization requests.
3. C. The office shall maintain a log of complaints against health insurers for failure to comply with the Prior Authorization Act. After two warnings issued by the superintendent of insurance, the office may levy a fine of not more than five thousand dollars ($5,000) on a health insurer that fails to comply with the provisions of the Prior Authorization Act.

4. D. By September 1, 2019, and each September 1 thereafter, the office shall provide an annual written report to the governor and the legislature to include, at a minimum:

   1. (1) prior authorization data for each health insurer and pharmacy benefits manager individually and for health insurers collectively;
   2. (2) the number and nature of complaints against individual health insurers and pharmacy benefits managers for failure to follow the Prior Authorization Act; and
   3. (3) actions taken by the office, including the imposition of fines, against individual health insurers and pharmacy benefits managers to enforce compliance with the Prior Authorization Act.
5. E. The annual written report shall be posted on the office's website.

History: Laws 2019, ch. 187, § 6; 2026, ch. 47, § 2.

ANNOTATIONS

Compiler's notes. — Laws 2019, ch. 187, § 6 was not enacted as part of the Insurance Code, but was compiled there for the convenience of the user.

The 2026 amendment, effective May 20, 2026, required the office of superintendent of insurance to include in its report to the governor and legislature prior authorization data for each pharmacy benefits manager, the number and nature of complaints against pharmacy benefits managers, and actions taken by the office of superintendent of insurance against pharmacy benefits managers; in Subsection D, after each occurrence of "health insurer" added "and pharmacy benefits manager".

Applicability. — Laws 2026, ch. 47, § 5 provided that the provisions of Laws 2026, ch. 47 apply to an individual or group policy, contract, certificate or agreement to provide, deliver, arrange for, pay for or reimburse any of the costs of medical care, pharmaceutical benefits or related benefits that is entered into, offered or issued by a health insurer or pharmacy benefits manager on or after January 1, 2027, pursuant to any of the following:

A. Chapter 59A, Article 22 NMSA 1978;

B. Chapter 59A, Article 23 NMSA 1978;

C. the Health Maintenance Organization Law [Chapter 59A, Article 46 NMSA 1978];

D. the Nonprofit Health Care Plan Law [Chapter 59A, Article 47 NMSA 1978]; or

E. the Health Care Purchasing Act [Chapter 13, Article 7 NMSA 1978].