Added definition of gold card program, process which healthcare provider may qualify for exemption from insurer or pharmacy benefits manager (PBM) prior authorization.
Revised prior authorization process by healthcare insurer using prior authorization process for healthcare services, specifically related to six-month evaluation period.
Updated timeline healthcare insurer has to provide to healthcare provider to provide medical records under Prior authorization transparency act, from 30 to 60 days.
If prescription drug, medicine, biological product, pharmaceutical, or pharmaceutical service not exempt from gold card program, then healthcare provider will be reviewed.
By healthcare insurer or pharmacy benefits manager under gold card program for prescription drug, medicine, biological product, pharmaceutical, or pharma service.
Discussed appeals process for disallowance of prior authorization of prescription drug, medicine, biological product, pharmaceutical, or pharmaceutical service requested.
Legislative History
On Jan. 29, 2025, bill introduced into House; on Mar. 17, 2025, bill passed in House.
On Mar. 17, 2025, bill introduced into Senate; on Apr. 3, 2025, bill passed the Senate.
On Apr. 4, 2025, delivered to governor; on Apr. 10, 2025, governor approved, Act 511.
Effectiveness
Act effective 91 days after legislature adjourned sine die (May 5), so Aug. 4, 2025.
