{"data":{"id":"us-ky/krs-304.17a-167","jurisdiction":"us-ky","citation":"KRS 304.17A-167","heading":"Processes and standards for electronic prior authorizations -- Prior","body":"authorization of drugs for ongoing medication therapy -- Requirements --\nTime span of authorization -- Exemptions.\n(1) On or before January 1, 2020, an insurer offering a health benefit plan shall\ndevelop, coordinate, or adopt a process for electronically requesting and\ntransmitting prior authorization for a drug by providers. The process shall be\naccessible by providers and meet the most recent National Council for Prescri ption\nDrug Programs SCRIPT standards for electronic prior authorization transactions\nadopted by the United States Department of Health and Human Services. Facsimile,\nproprietary payer portals, and electronic forms shall not be considered electronic\ntransmission.\n(2) Unless otherwise provided in subsection (3) of this section or prohibited by state or\nfederal law, if a provider receives a prior authorization for a drug prescribed to a\ncovered person with a condition that requires ongoing medication therapy, and the\nprovider continues to prescribe the drug, and the drug is used for a condition that is\nwithin the scope of use approved by the United States Food and Drug\nAdministration or has been proven to be a safe and effective form of treatment for\nthe patient's specific underlying condition based on clinical practice guidelines that\nare developed from peer -reviewed publications, the prior authorization received\nshall:\n(a) Be valid for the lesser of:\n1. One (1) year from the date the provider receives the prio r authorization;\nor\n2. Until the last day of coverage under the covered person's health benefit\nplan during a single plan year; and\n(b) Cover any change in dosage prescribed by the provider during the period of\nauthorization.\n(3) (a) Except as provided in paragraph (b) of this subsection, the provisions of\nsubsection (2) of this section shall not apply to:\n1. Medications that are prescribed for a non-maintenance condition;\n2. Medications that have a typical treatment period of less than twelve (12)\nmonths;\n3. Medications where there is medical or scientific evidence that does not\nsupport a twelve (12) month approval; or\n4. Medications that are opioid analgesics or benzodiazepines.\n(b) Paragraph (a) of this subsection shall not apply to any medication that is\nprescribed to a patient in a community-based palliative care program.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=49552","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:46Z","sha256":"d1b50c87670d9ef27b1847f237c49c2fe58441f4739b2e94a9409e4166a473dc","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-166","next":"us-ky/krs-304.17a-168"},"notice":"GroundRules: Original legal text. Not legal advice."}