Effect of change in prior authorization clinical criteria

1. If, during a plan year, a prior authorization review organization changes coverage terms for a health care service or the clinical criteria used to conduct prior authorizations for a health care service, the change in coverage terms or in clinical criteria does not apply until the next plan year for any enrollee who received prior authorization for a health care service using the coverage terms or clinical criteria in effect before the effective date of the change. 2. This section does not apply if a prior authorization review organization changes coverage terms for a drug or device that has been: a. Deemed unsafe by the United States food and drug administration; or b. Withdrawn by the United States food and drug administration or product manufacturer.