SB3 Alabama 2013 Session

Summary

Primary Sponsor

Gerald O. Dial

Republican

Session

Regular Session 2013

Title

Medicaid programs, ensuring appropriate access to medicines for premature infants, created, Medicaid program required to develop and implement policies to streamline process for access to covered drug for premature infants.

Summary

The bill would require Alabama Medicaid to speed up and standardize access to outpatient drugs for premature infants, including a 24-hour prior authorization decision process.

What This Bill Does

It creates the Ensuring Appropriate Access to Medicines for Premature Infants Act and requires the Medicaid Agency to develop policies to streamline prior authorization for covered outpatient drugs for premature infants and to ensure timely access to care. It sets a 24-hour deadline for approving or denying prior authorization requests, with rationale and an appeals process, and provides fast-track decisions for seasonal or periodic drugs. It also requires electronic, fax, or telephone submission, public posting of PA requirements, a strong appeals framework with continued coverage during appeals and access to patient files, dosage requirements per FDA labeling, and annual reporting on health outcomes related to denied drugs.

Who It Affects

• Premature infants and their families, who would gain faster access to prescribed outpatient drugs and related care.
• Healthcare providers and Medicaid programs, who must implement and follow the streamlined prior authorization process and 24-hour decision requirements.

Key Provisions

• 24-hour decision requirement for prior authorization with rationale and appeals information; fast-track for seasonal/periodic drugs; contact provider to clarify questions; requests deemed approved if not adjudicated within 24 hours.
• Prior authorization may be submitted electronically, by fax, or by telephone.
• Public posting on the Medicaid Agency website of all prior authorization requirements, forms, supporting materials, rationale, and appeals processes by therapeutic area or drug.
• Standards for an appeals process that allows evidence-based appeals, continued coverage during appeals, access to patient records, timely reviews, and consumer protections from the Uniform External Review Model Act.
• All prescribed medicines for premature infants must follow the dosage and duration specified in FDA labeling.
• The Medicaid Agency must monitor health outcomes for premature infants denied a drug and report annual data and findings to the Legislature.
• Develop standards and common practices across Medicaid programs to ensure timely and appropriate access to care for premature infants.
• All policies and procedures created under this act are binding for all Medicaid programs in Alabama.
• Effective date: immediate upon passage and governor’s approval.

AI-generated summary using openai/gpt-5-nano on Feb 25, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Medicaid Agency