All Roll Calls
Yes: 317 • No: 1
Sponsored By: Patrick A. Hope (Democratic)
Became Law
Prior authorization; requiring physician review for denial. Prohibits a health insurance carrier from making an adverse determination of a prior authorization request (i) for prescription drugs unless such denial has been reviewed and approved by a licensed physician or, if a licensed physician is not available, by a licensed pharmacist or (ii) for health care services unless such adverse determination has been reviewed and approved by (a) a licensed physician; (b) in the case of mental health services, a licensed mental health provider if a licensed physician is unavailable; or (c) in the case of dental services, a licensed dentist if a licensed physician is unavailable.
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10 provisions identified: 7 benefits, 2 costs, 1 mixed.
Beginning January 1, 2027, once a prior authorization for services is approved and care is scheduled or provided as approved, the insurer cannot revoke or limit it. Exceptions are if the provider asks to change it, there is fraud or misrepresentation, or a federal regulator or manufacturer pulls or limits the service for safety. The rule does not require authorization if you are no longer enrolled.
The drug prior-authorization protections do not apply to Medicare, Medicaid, CHIP, the Federal Employees Health Benefits program, or TRICARE, and to several limited‑benefit plans (like accident‑only, disability, long‑term care, dental, and vision). Certain HMOs that meet listed integrated and interoperability rules may also be excluded. These exclusions apply until January 1, 2027.
A drug prior authorization cannot be denied unless a licensed physician reviews and approves the denial. If no physician is available, a licensed pharmacist may review drug denials. This clinical review rule applies now and continues on and after January 1, 2027.
Beginning January 1, 2027, a denial of prior authorization for medical services must be reviewed and approved by a licensed physician. If no physician is available, a licensed mental health provider may review mental health service denials, and a licensed dentist may review dental denials.
Beginning January 1, 2027, urgent prior authorization requests for medical services get a response within 72 hours, including weekends. Standard requests get an answer within seven calendar days. If more information is required, the insurer must say exactly what is needed and then decide within the 72‑hour or seven‑day limit after complete info is sent.
Starting July 1, 2025, insurers run an online prior authorization system that links to e‑prescribing and EHRs and shows real-time out‑of‑pocket costs. They must accept requests by phone, fax, or approved electronic systems, and can auto‑approve some requests when no extra review is needed. Urgent drug requests get a reply within 24 hours, including weekends; standard, fully complete requests get an answer within two business days. If more info is needed, the insurer must say exactly what from the record is needed and decide within two business days after it is sent. Insurers must give a tracking ID, explain any denial, and post formularies, PA lists, procedures, and forms in one place online (updated within seven days). No one can be charged a fee to use the online process. These drug rules apply until January 1, 2027.
If you switch plans, your new insurer must honor a prior authorization from your old plan for the first 90 days when your prescriber sends proof. If you change plans within the same insurer, it must honor the old approval as long as the drug is still a covered benefit. A prior approval stays valid for non‑opioid drugs when your prescriber changes the dose within FDA‑labeled limits. Insurers generally cannot revoke an approved drug authorization after the drug was scheduled or given, except for fraud, new safety or regulatory actions, serious interactions, or a new generic/biosimilar. Mental health drugs that are covered, at FDA doses, used for at least three continuous months, and reviewed yearly by your prescriber do not need a new PA; at least one covered substance use treatment drug must be available without PA if it follows FDA and Board rules. In some cases, an approval must be honored even if a drug is later removed from the formulary. These drug protections apply until January 1, 2027.
Beginning January 1, 2027, insurers must post a public web page listing services and codes that need prior authorization, how to request it, and effective dates, and update it by each change’s effective date. Providers must get at least 30 days’ notice before changes take effect. In a pandemic, disaster, or other emergency, insurers can remove prior authorization right away. Each year by March 31, insurers must post plan‑level prior authorization data for the prior year. If the insurer did not post the rules for your date of service, it cannot deny your claim for missing prior authorization.
Starting July 1, 2025, providers must ensure their e‑prescribing or EHR system can connect to each insurer’s online prior authorization and real-time benefit tools at the point of prescribing. Providers can ask for a waiver if this causes undue hardship. Carriers cannot use the online process to access provider data beyond the enrollee’s data without the provider’s consent. By July 1, 2024, carriers must share contact info for any third‑party vendor they use (posting it online counts). This mandate ends January 1, 2027.
Beginning January 1, 2027, if your HMO contracts with an employed multispecialty physician group and provides care through that group or contracted community providers, the new service prior-authorization rules in this section do not apply to that plan.
Patrick A. Hope
Democratic • House
There are no cosponsors for this bill.
All Roll Calls
Yes: 317 • No: 1
House vote • 3/10/2026
Senate substitute agreed to by House
Yes: 98 • No: 1
Senate vote • 3/5/2026
Commerce and Labor Substitute agreed to
Yes: 0 • No: 0
Senate vote • 3/5/2026
Passed Senate with substitute Block Vote
Yes: 39 • No: 0
Senate vote • 3/4/2026
Constitutional reading dispensed Block Vote (on 2nd reading)
Yes: 39 • No: 0
Senate vote • 3/4/2026
Passed by for the day Block Vote (Voice Vote)
Yes: 0 • No: 0
Senate vote • 3/2/2026
Reported from Commerce and Labor with substitute
Yes: 13 • No: 0
House vote • 2/4/2026
Read third time and passed House
Yes: 97 • No: 0
House vote • 1/29/2026
Reported from Labor and Commerce with substitute
Yes: 22 • No: 0
House vote • 1/27/2026
Subcommittee recommends reporting with substitute
Yes: 9 • No: 0 • Other: 1
Fiscal Impact Statement from State Corporation Commission (HB481)
Acts of Assembly Chapter text (CHAP0925)
Approved by Governor-Chapter 925 (effective 7/1/2026)
Governor's Action Deadline 11:59 p.m., April 13, 2026
Enrolled Bill communicated to Governor on March 31, 2026
Signed by Speaker
Bill text as passed House and Senate (HB481ER)
Enrolled
Signed by President
Senate substitute agreed to by House (98-Y 1-N 0-A)
Passed by for the day
Fiscal Impact Statement from State Corporation Commission (HB481)
Passed Senate with substitute Block Vote (39-Y 0-N 0-A)
Commerce and Labor Substitute agreed to
Engrossed by Senate - committee substitute
Read third time
Passed by for the day Block Vote (Voice Vote)
Constitutional reading dispensed Block Vote (on 2nd reading) (39-Y 0-N 0-A)
Rules suspended
Committee substitute printed 26108765D-S1
Senate committee offered
Reported from Commerce and Labor with substitute (13-Y 0-N)
Referred to Committee on Commerce and Labor
Constitutional reading dispensed (on 1st reading)
Read third time and passed House (97-Y 0-N 0-A)
Chaptered
4/13/2026
Enrolled
3/30/2026
Substitute
3/3/2026
Substitute
3/2/2026
Substitute
1/29/2026
Substitute
1/28/2026
Substitute
1/27/2026
Introduced
1/12/2026
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