INSURANCE; PRIOR AUTHORIZATIONS
Sponsored By: SENATE LABOR & COMMERCE
Became Law
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Bill Overview
Analyzed Economic Effects
5 provisions identified: 4 benefits, 0 costs, 1 mixed.
Fewer hurdles for needed prescription drugs
Beginning January 1, 2027, plans must offer a clear online way to ask for a step‑therapy exception. They must grant it if you tried and stopped the required drugs due to no benefit or bad effects. They must also grant it if your provider says the drug is needed to save your life. For Stage 4 metastatic cancer, if the drug is FDA‑approved, on the plan’s formulary, and backed by FDA use, National Comprehensive Cancer Network Category 1 or 2A, or peer‑reviewed research, step therapy is banned. Insurers may still require you to try a generic or another brand under normal coverage rules.
Clearer rules and fairer medical reviews
Beginning January 1, 2027, prior authorization rules must use peer‑reviewed, evidence‑based criteria and be updated at least yearly. Insurers must post clear standards online, including required documents and whether electronic submission is available, plus key dates. If insurer and its review group have different rules, the one more favorable to you applies. If a request is denied, the notice must explain the clinical reasons, list missing items, and show how and when to appeal. Your provider can request a clinical peer review by a qualified reviewer who attests they reviewed your records, and the insurer must share the reviewer’s credentials.
Faster prior authorizations and auto‑approvals
Beginning January 1, 2027, insurers must decide expedited requests in 24 hours. They must decide standard requests in 72 hours, or 72 hours excluding weekends if sent by fax. If information is missing, they must ask within 1 day (expedited) or 3 days (standard). When they ask for more, they can set a due date 5–14 working days from the original receipt and must tell you and your provider what is needed. They must give a timestamped receipt when they get a request. If they miss the deadline, the request is automatically approved.
Longer approvals for chronic and other care
Beginning January 1, 2027, a prior authorization for a chronic condition lasts at least 12 months while you keep the plan. If your care plan is unchanged and your provider certifies you are following it, approval renews for another 12 months. For other care and drugs, an authorization is valid for 90 days unless your plan sets a different length.
Tech upgrades and oversight for authorizations
Beginning January 1, 2027, insurers must run a prior authorization API that follows federal CMS standards and supports requests and decisions. Each insurer must file yearly reports on timelines, denials and appeals, API status, and approval times for its 20 most used codes with demographics. The insurance director examines insurers at least every two years and can fine up to $25,000 per instance, order fixes, or suspend or revoke authority. Insurers must keep a reasonable, efficient process that limits paperwork, and the law defines key terms to guide compliance.
Sponsors & Cosponsors
Sponsor
SENATE LABOR & COMMERCE
Affiliation unavailable
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
(S) EFFECTIVE DATE(S) OF LAW SEE CHAPTER
7/30/2025Senate(S) LAW W/O GOV SIGNATURE 7/15 CHAPTER 21 SLA 25
7/30/2025Senate(S) MANIFEST ERROR(S)
7/30/2025Senate(S) 3:20 P.M. 6/23/25 TRANSMITTED TO GOVERNOR
7/30/2025Senate(H) VERSION: CSSB 133(L&C)
5/18/2025House(H) RETURN TO (S), TRANSMIT TO GOV NEXT
5/18/2025House(H) EFFECTIVE DATE(S) SAME AS PASSAGE
5/18/2025House(H) PASSED ON RECONSIDERATION Y40
5/18/2025House(H) RECON SAME DAY UC - IN THIRD READING
5/18/2025House(H) RUFFRIDGE NOTICE OF RECONSIDERATION
5/18/2025House(H) EFFECTIVE DATE(S) SAME AS PASSAGE
5/18/2025House(H) PASSED Y40
5/18/2025House(H) READ THE THIRD TIME CSSB 133(L&C)
5/18/2025House(H) ADVANCED TO THIRD READING Y33 N7
5/18/2025House(H) ADVANCED TO THIRD READING NEXT CALENDAR
5/18/2025House(H) READ THE SECOND TIME
5/18/2025House(H) RULES TO CALENDAR 5/18/2025
5/18/2025House(H) FIN REFERRAL REMOVED
5/16/2025House(H) FN1: ZERO(CED)
5/16/2025House(H) DP: BURKE, CARRICK, SADDLER, NELSON, FIELDS, HALL
5/16/2025House(H) L&C RPT 6DP
5/16/2025House(H) Moved CSSB 133(L&C) Out of Committee -- Delayed to 15 min Following Session --
5/14/2025House(H) LABOR & COMMERCE at 03:15 PM BARNES 124
5/14/2025HouseAudio/Video
5/14/2025House(H) L&C, FIN
5/13/2025House
Bill Text
Enrolled SB 133
5/18/2025
CSSB 133(L&C)
4/4/2025
SB 133
3/17/2025