An Act relating to prior authorization requests for medical care covered by a health care insurer; relating to a prior authorization application programming interface; relating to step therapy; and providing for an effective date.

34th Legislature (2025-2026)

SB 133 streamlines prior authorization for medical care, ensuring timely responses from insurers, reducing delays, and enhancing patient access to necessary treatments.

(S) EFFECTIVE DATE(S) OF LAW SEE CHAPTER

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Summary of SB 133

Bill Number: SB 133
Title: An Act relating to prior authorization requests for medical care covered by a health care insurer; relating to a prior authorization application programming interface; relating to step therapy; and providing for an effective date.
Status: (S) EFFECTIVE DATE(S) OF LAW SEE CHAPTER
Introduced: March 17, 2025
Classification: Bill
Subject Areas: Appeals, Claims, Contractors, Data Processing, Disclosure, Drugs, Health & Social Services, Insurance, Medical Care, Occupations & Professions

Purpose and Intent

SB 133 aims to streamline the process of prior authorization requests for medical care covered by health care insurers. The bill seeks to enhance transparency and efficiency in the authorization process, which is often criticized for causing delays in patient care. Additionally, it introduces provisions for a standardized application programming interface (API) to facilitate these requests and addresses the practice of step therapy.

Key Provisions

Prior Authorization Requests:

Establishes clearer guidelines for health care insurers regarding the handling of prior authorization requests.
Mandates that insurers respond to requests within a specified timeframe to reduce delays in patient treatment.

Application Programming Interface (API):

Requires the development of a standardized API for prior authorization requests, enabling healthcare providers to submit and track requests electronically.
Aims to improve communication between insurers and healthcare providers, thereby reducing administrative burdens.

Step Therapy Protocols:

Defines and regulates the use of step therapy, which requires patients to try less expensive treatments before moving on to more costly options.
Ensures that patients have the right to appeal decisions made under step therapy protocols, promoting patient-centered care.

Effective Date:

The provisions of the bill will take effect as specified in the law, ensuring timely implementation of the new regulations.

Impact

Healthcare Providers: The bill is expected to reduce the administrative workload on healthcare providers by simplifying the prior authorization process and providing a digital platform for submissions.

Patients: Patients may experience faster access to necessary medical treatments due to the mandated response times and the ability to appeal step therapy decisions.

Health Insurers: Insurers will need to adapt to the new requirements for processing prior authorization requests and implementing the API, which may involve changes to their operational systems.

Conclusion

SB 133 represents a significant step towards improving the efficiency and transparency of the prior authorization process in healthcare. By establishing clear guidelines and technological solutions, the bill aims to enhance patient care and reduce unnecessary delays in treatment. The effective date of the law will ensure that these changes are implemented promptly, benefiting both patients and healthcare providers.