{"data":{"id":"us-nm/59a-47-47","jurisdiction":"us-nm","citation":"59A-47-47","heading":"Prescription drug prior authorization protocols.","body":"A. After January 1, 2014, a health care plan 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 care plan 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 care plan\" means a nonprofit corporation authorized by the superintendent to enter into contracts with subscribers and to make health care expense payments but does not include:\n(1) a person that only issues a limited-benefit policy intended to supplement major medical coverage, including medicare supplement, vision, dental, disease-specific, accident-only or hospital indemnity-only insurance policies, or that only issues policies for long-term care or disability income;\n(2) a physician or a physician group to which a health care plan has delegated financial risk for prescription drugs and that does not use a prior authorization process for prescription drugs; or\n(3) a health care plan or its affiliated providers, if the health care plan owns and operates its pharmacies and does not use a prior authorization process.","path":["Chapter 59A - Insurance Code","ARTICLE 47 Nonprofit Health Care Plans"],"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":"088349156ad70f3d0353349f5def952e27ed55424ec8ec9fb1869a955e02fe74","source_id":"us-nm","stale":false,"prev":"us-nm/59a-47-46","next":"us-nm/59a-47-47.1"},"notice":"GroundRules: Original legal text. Not legal advice."}