{"data":{"id":"us-nm/59a-23-12","jurisdiction":"us-nm","citation":"59A-23-12","heading":"Prescription drug prior authorization protocols.","body":"A. After January 1, 2014, an 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 an 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, \"insurer\":\n(1) means:\n(a) an 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) an insurer or its affiliated providers, if the insurer owns and operates its pharmacies and does not use a prior authorization process for prescription drugs.","path":["Chapter 59A - Insurance Code","ARTICLE 23 Group and Blanket 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":"35b66943e55c8e0e46a0c2f52de3c90a7cf5fe8abe5a2cbf44b87de233d81c3f","source_id":"us-nm","stale":false,"prev":"us-nm/59a-23-11","next":"us-nm/59a-23-12.1"},"notice":"GroundRules: Original legal text. Not legal advice."}