An Act Regarding Prior Authorizations for Prescription Drugs”
Maine Legislature, Session 129, LD 2106
Committee Amendment CA_A_S452 (Senate)
Amends: 24-A MRSA §4304

COMMITTEE AMENDMENT “      ” to S.P. 752, L.D. 2106, Bill, “An Act 
Regarding Prior Authorizations for Prescription Drugs”
Amend the bill by striking out everything after the enacting clause and inserting the 
following:
'Sec. 1.  24-A MRSA §4304, sub-§2, as amended by PL 2019, c. 273, §1, is 
further amended to read:
2.  Prior authorization of nonemergency services.  Except for a request in exigent 
circumstances as described in section 4311, subsection 1-A, paragraph B, a request by a 
provider for prior authorization of a nonemergency service must be answered by a carrier 
within 72 hours or 2 business days, whichever is less, in accordance with this subsection.
A.  Both the provider and the enrollee on whose behalf the authorization was 
requested must be notified by the carrier of its determination.
B.  If the carrier responds to a request by a provider for prior authorization with a 
request for additional information, the carrier shall make a decision within 72 hours 
or 2 business days, whichever is less, after receiving the requested information.
C.  If the carrier responds that outside consultation is necessary before making a 
decision, the carrier shall make a decision within 72 hours or 2 business days, 
whichever is less, from the time of the carrier's initial response.
D.  The prior authorization standards used by a carrier must be clear and readily 
available to enrollees, participating providers, pharmacists and other providers.  With 
regard to prior authorization for prescription drugs, a carrier shall comply with the 
requirements set forth in subsection 2-B.  A provider must make best efforts to 
provide all information necessary to evaluate a request, and the carrier must make 
best efforts to limit requests for additional information.
If a carrier does not grant or deny a request for prior authorization within the time frames 
required under this subsection, the request for prior authorization by the provider is 
granted.
Date: 
(Filing No. S-          )
COMMITTEE AMENDMENT “      ” to S.P. 752, L.D. 2106
COMMITTEE AMENDMENT
Sec. 2.  24-A MRSA §4304, sub-§2-B, as enacted by PL 2019, c. 273, §2, is 
amended to read:
2-B.  Electronic transmission of prior authorization requests.  Beginning no later 
than January 1, 2020, if a health plan provides coverage for prescription drugs, the carrier 
must accept and respond to prior authorization requests in accordance with subsection 2 
and this subsection through a secure electronic transmission using standards 
recommended by a national institute for the development of fair standards and adopted by 
a national council for prescription drug programs for electronic prescribing transactions.  
For the purposes of this subsection, transmission of a facsimile through a proprietary 
payer portal or by use of an electronic form is not considered electronic transmission.  A 
carrier's electronic transmission system for prior authorization requests for prescription 
drugs must comply with the following.
A.  No later than January 1, 2022, unless a waiver is granted by the superintendent, a 
carrier or entity under contract to a carrier shall make available to a provider in real 
time at the point of prescribing one or more electronic benefit tools that are capable 
of integrating with at least one electronic prescribing system or electronic medical 
record system to provide complete, accurate, timely, clinically appropriate formulary 
and benefit information specific to an enrollee, including, but not limited to, enrollee 
cost-sharing information, information on any available formulary alternatives that are 
clinically appropriate and information about the formulary status and the utilization 
review and prior authorization requirements of each drug presented.  Upon a carrier's 
request, the superintendent may grant a waiver from the requirements of this 
paragraph based on a demonstration of good cause.
Sec. 3.  Bureau of Insurance to monitor compliance.  Beginning January 1, 
2021, the Department of Professional and Financial Regulation, Bureau of Insurance shall 
monitor compliance by carriers authorized to do business in this State with the 
requirements of the Maine Revised Statutes, Title 24-A, section 4304, subsection 2-B 
using its authority under Title 24-A, section 221.  The bureau shall also request 
information from carriers on the adoption and usage of electronic transmission by health 
care providers for requesting prior authorization for prescription drugs from carriers.  No 
later than June 1, 2022, the bureau shall submit a report to the joint standing committee of 
the Legislature having jurisdiction over health coverage and insurance matters on the 
status of compliance by carriers.  If the bureau determines that a carrier is not complying 
with the requirements of Title 24-A, section 4304, subsection 2-B, the bureau shall take 
enforcement action against the carrier as appropriate.  The joint standing committee of the 
Legislature having jurisdiction over health coverage and insurance matters may report out 
a bill to the First Regular Session of the 131st Legislature based on the report.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively.
SUMMARY
This amendment replaces the bill and makes the following changes.
1.  It requires carriers to provide by January 1, 2022 at least one electronic tool to 
facilitate the availability of certain prescription drug benefit information in real time at 
COMMITTEE AMENDMENT “      ” to S.P. 752, L.D. 2106
COMMITTEE AMENDMENT
the point of prescribing and when submitting prior authorization requests for prescription 
drugs. It also permits the Superintendent of Insurance to grant a waiver from the 
requirements for good cause.
2.  It requires the Department of Professional and Financial Regulation, Bureau of 
Insurance to monitor compliance by carriers with the requirements of law related to 
electronic transmission of prior authorization requests for prescription drugs and to 
submit a report to the joint standing committee of the Legislature having jurisdiction over 
health coverage and insurance matters on the status of that compliance by June 1, 2022.
FISCAL NOTE REQUIRED
(See attached)
Approved: 04/03/20
LD 2106
LR 2690(02)
Fiscal Detail and Notes
Minor cost increase - Other Special Revenue Funds
Any additional costs to the Department of Professional and Financial Regulation, Bureau of Insurance, to monitor 
compliance as required in this bill are expected to be minor and can be absorbed within existing budgeted resources.
An Act Regarding Prior Authorizations for Prescription Drugs
Fiscal Note for Bill as Amended by Committee Amendment " "
Committee: Health Coverage, Insurance and Financial Services
Fiscal Note Required: Yes
Fiscal Note
LR2690(02) - Fiscal Note - Page 1 of 1