{"data":{"id":"us-nm/26-1-18.1","jurisdiction":"us-nm","citation":"26-1-18.1","heading":"Prescription drug prior authorization protocols.","body":"A. After January 1, 2014, a prescribing practitioner seeking prior authorization from a health insurer may use the uniform prior authorization form developed pursuant to Sections 2 [59A-2-9.8 NMSA 1978] and 3 [61-11-6.2 NMSA 1978] of this 2013 act.\nB. As used in this section:\n(1) \"health insurer\" means a health insurer; a nonprofit health service provider; a health maintenance organization; a managed care organization; or a provider service organization. \"Health insurer\" does not include:\n(a) a person that delivers, issues for delivery or renews an individual policy intended to supplement major medical group-type coverages such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or other limited-benefit health insurance policy;\n(b) a physician or a physician group to which a health insurer has delegated financial risk for prescription drugs and that does not use a prior authorization process for prescription drugs; or\n(c) a health insurer or its affiliated providers if the health insurer owns and operates its pharmacies and does not use a prior authorization process for prescription drugs; and\n(2) \"prescribing practitioner\" means a person that is licensed or certified to prescribe and administer drugs that are subject to the New Mexico Drug, Device and Cosmetic Act.","path":["Chapter 26 - Drugs and Cosmetics","ARTICLE 1 General Provisions"],"source_url":"https://nmonesource.com/nmos/nmsa-unanno/en/item/18526/index.do","current_through":"2025-12-31","vintage":"","retrieved_at":"2026-09-03T15:02:19Z","sha256":"3b8cbc59f9533617701f95163e9671f1757694aeb44f72a42c5e0f47e079ae4a","source_id":"us-nm","stale":false,"prev":"us-nm/26-1-18","next":"us-nm/26-1-19"},"notice":"GroundRules: Original legal text. Not legal advice."}