KRS 304.17A-167: Processes and standards for electronic prior authorizations -- Prior

authorization of drugs for ongoing medication therapy -- Requirements --

Time span of authorization -- Exemptions.

(1) On or before January 1, 2020, an insurer offering a health benefit plan shall

develop, coordinate, or adopt a process for electronically requesting and

transmitting prior authorization for a drug by providers. The process shall be

accessible by providers and meet the most recent National Council for Prescri ption

Drug Programs SCRIPT standards for electronic prior authorization transactions

adopted by the United States Department of Health and Human Services. Facsimile,

proprietary payer portals, and electronic forms shall not be considered electronic

transmission.

(2) Unless otherwise provided in subsection (3) of this section or prohibited by state or

federal law, if a provider receives a prior authorization for a drug prescribed to a

covered person with a condition that requires ongoing medication therapy, and the

provider continues to prescribe the drug, and the drug is used for a condition that is

within the scope of use approved by the United States Food and Drug

Administration or has been proven to be a safe and effective form of treatment for

the patient's specific underlying condition based on clinical practice guidelines that

are developed from peer -reviewed publications, the prior authorization received

shall:

(a) Be valid for the lesser of:

1. One (1) year from the date the provider receives the prio r authorization;

or

2. Until the last day of coverage under the covered person's health benefit

plan during a single plan year; and

(b) Cover any change in dosage prescribed by the provider during the period of

authorization.

(3) (a) Except as provided in paragraph (b) of this subsection, the provisions of

subsection (2) of this section shall not apply to:

1. Medications that are prescribed for a non-maintenance condition;

2. Medications that have a typical treatment period of less than twelve (12)

months;

3. Medications where there is medical or scientific evidence that does not

support a twelve (12) month approval; or

4. Medications that are opioid analgesics or benzodiazepines.

(b) Paragraph (a) of this subsection shall not apply to any medication that is

prescribed to a patient in a community-based palliative care program.