{"data":{"id":"us-nm/59a-22-52","jurisdiction":"us-nm","citation":"59A-22-52","heading":"Prescription drug prior authorization protocols.","body":"A. After January 1, 2014, a health insurer shall accept 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 as sufficient to request prior authorization for prescription drug benefits.\nB. No later than twenty-four months after the adoption of national standards for electronic prior authorization, a health insurer shall exchange prior authorization requests with providers who have e-prescribing capability.\nC. If a health insurer fails to use or accept the uniform prior authorization form or fails to respond within three business days upon receipt of a uniform prior authorization form, the prior authorization request shall be deemed to have been granted.\nD. As used in this section, \"health insurer\":\n(1) means:\n(a) a health insurer;\n(b) a nonprofit health service provider;\n(c) a health maintenance organization;\n(d) a managed care organization; or\n(e) a provider service organization; and\n(2) 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.","path":["Chapter 59A - Insurance Code","ARTICLE 22 Health Insurance Contracts"],"source_url":"https://nmonesource.com/nmos/nmsa-unanno/en/item/18562/index.do","current_through":"2026-07-01","vintage":"","retrieved_at":"2026-09-03T15:02:20Z","sha256":"61c2c18c5aa179de4aed022b88995bf10a7b31fc7b7137f56d48c442554a376e","source_id":"us-nm","stale":false,"prev":"us-nm/59a-22-51","next":"us-nm/59a-22-53"},"notice":"GroundRules: Original legal text. Not legal advice."}