An Act To
Maine Legislature, Session 126, LD 0984
Committee Amendment CA_A_S123 (Senate)
Amends: 24-A MRSA §4304

MAINE STATE LEGISLATURE 
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Reproduced from scanned originals with text recognition applied 
(searchable text may contain some errors and/or omissions) 
~ 
Date 6J~ 4/11'" 
Ma.iority 
L.D.984 
(Filing No. S-/'-3 ) 
INSURANCE AND FINANCIAL SERVICES 
Reproduced and distributed under the direction of the Secretary of the Senate. 
SENATE 
12:6TH LEGISLATURE 
COMMITTEE AMENDMENT "A" to S.P. 329, L.D. 984, Bill, "An Act To 
Amend the Health Plan Improvement Law Regarding Prescription Drug Step Therapy 
and Prior Authorization" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 24-A MRSA §4304, sub-§l-A is enacted to read: 
I-A. Prescription drug step therapy. The clinical review criteria used by a carrier 
in approving prescription drugs: 
A. May not require dispensing of a medication for an off-label use; and 
B. May not require failure on the same medication on more than one occasion for 
enrollees continuously enrolled in a health plan offered by the carrier. 
Sec. 2. 24-A MRSA §4304, sub-§2-A is enacted to read: 
2-A. 
Prior authorization of prescription drug or pharmacy services. 
Notwithstanding subsection 2, requests by a provider for prior authorization of a 
nonemergency prescription drug or pharmacy service must be answered by a carrier 
within 24 hours by telephone or other telephonic or electronic communications device. 
Both the provider and the enrolle'~ on whose behalf the authorization was requested must 
be notified by the carrier of its determination. If the information submitted is insufficient 
to make a decision, the carrier shall notify the provider within 24 hours by telephone or 
other telephonic or electronic communications device of the additional information 
necessary to render a decision. If the carrier determines that outside consultation is 
necessary, the carrier shall notify the provider and the enrollee for whom the service was 
requested within 24 hours by telephone or other telephonic or electronic communications 
device. The carrier shall make a good faith estimate of when the final determination will 
be made and contact the enrollee and the provider as soon as practicable. If a carrier fails 
to respond within 24 hours after receiving a completed prior authorization request from a 
health care practitioner, the prior authorization request is deemed to have been granted.' 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT 'A .. to S.P. 329, L.D. 984 
SU~y 
This amendment is the majority report of the committee and replaces the bill. The 
amendment provides that the clinical review criteria used by a carrier in approving 
prescription drugs may not require dispensing of a medication for an off-label use and, as 
in the bill, may not require failure on the same medication on more than one occasion for 
enrollees continuously enrolled in a health plan offered by the carrier. The amendment 
also requires health insurance carriers to respond to nonemergency prescription drug prior 
authorization requests within 24 hours. The bill reduces the time to respond to 24 hours 
for all non emergency services prior authorization requests. 
COMMITTEE AMENDMENT