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Electronic Exchange of
Prescription Drug Pre-Authorization

HB 232 Focus Group

Under the direction of the Utah Insurance Department, the Utah Health Information Network (UHIN) convened a focus group of payers, providers, and pharmacists within the community to discuss legislation regarding pharmacy prior authorizations. House Bill 323 was sponsored by Bradley G. Last and Even J. Vickers, was passed during the 2013 Utah General Legislative Session and was signed by Governor Gary Herbert on April 1, 2013. This bill amends the Insurance Code related to health insurance and requires a review of prior authorization forms for prescription drugs. The scope of this project was to review the prior authorization process, review the current data standards that apply, consult with industry groups, and present the findings.

Focus Group Findings

The initial work has been completed and the focus group’s findings were presented to the Legislature’s Business and Labor Interim Committee on September 18, 2013. The focus group’s findings for House Bill 323 were well received and since that time UHIN has met with the Utah Insurance Department, to discuss the focus groups next steps. The group will hold regular meetings, the next scheduled on February 2nd. Upcoming discussions will focus on the short term opportunities previously identified. A representative from the Utah Insurance Department will participate in upcoming meetings.

Payers that have interest in attending the focus group meetings are invited to attend. Those interested in attending meeting and/or receiving meeting agendas and minutes may contact Cameron Gunderson at cgunderson@uhin.org.

House Bill 323

Utah Code Annotated 31A-22-614.7

Uniform claims processing -- Electronic exchange of prescription drug pre-authorization.

(1) The commissioner shall consult with national and state organizations involved with the standardized exchange of health data, and the electronic exchange of health data, to study and review:
(a) The process of prior authorization of prescription drugs; and
(b) The standards for the use and electronic exchange of a uniform prescription drug prior authorization form that meet federal mandatory minimum standards and follow the adoption of national requirements for transaction and data elements in the federal Health Insurance Portability and Accountability Act.
 (2) The commissioner and the organization described in Subsection (1) shall report their progress and findings to the Legislature's Business and Labor Interim Committee before October 1,2013 and before November 1, 2014.

 

Enacted by Chapter 361, 2013 General Session