An Act to Ensure Ongoing Access to Medications and Care for
Maine Legislature, Session 132, LD 1496
Committee: Health Coverage, Insurance and Financial Services
Sponsors: ZAGER, BENNETT
Amends: 24-A MRSA §4304-B, 24-A MRSA §4311

Legislative Document
No. 1496
H.P. 980
House of Representatives, April 8, 2025
An Act to Ensure Ongoing Access to Medications and Care for 
Chronic Conditions and Conditions Requiring Long-term Care by 
Changing Requirements for Prior Authorizations
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative ZAGER of Portland.
Cosponsored by Senator BENNETT of Oxford and
Representatives: DUCHARME of Madison, MASTRACCIO of Sanford, Senators: BAILEY of 
York, BRENNER of Cumberland, FARRIN of Somerset.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §4304-B is enacted to read:
§4304-B.  Prior authorization for treatment of chronic conditions and conditions 
requiring long-term care
1.  Length of prior authorization for treatment for chronic conditions and 
conditions requiring long-term care.  If a utilization review entity requires a prior 
authorization for health care services for the treatment of a chronic condition or a condition 
requiring long-term care, the approved prior authorization remains valid for the duration of 
the treatment or for one year, whichever is longer. If health care services for the treatment 
of a chronic condition or a condition requiring long-term care are necessary for more than 
one year, a utilization review entity may not require the renewal of the prior authorization 
more frequently than once every 5 years. The prior authorization approval is valid from the 
date the enrollee receives the notice of the approval. If an enrollee has received prior 
authorization for health care services for the treatment of a chronic condition or a condition 
requiring long-term care, the carrier shall honor the prior authorization until the prior 
authorization expires as long as the enrollee continues to be covered under the same health 
plan.
2.  Coverage restriction prohibition; notice.  A health plan may not restrict coverage 
for a health care service under this section, including a prescription, that received prior 
authorization approval under a previous health plan within 90 days of enrollment in the 
new health plan by an enrollee who is stable on that health care service, as determined by 
a health care provider. The health plan must provide the enrollee with at least 90 days' 
notice prior to restricting coverage pursuant to this subsection.
Sec. 2.  24-A MRSA §4311, sub-§1-A, ¶A, as amended by PL 2019, c. 273, §3, is 
further amended to read:
A.  The carrier must determine whether it will cover the drug requested and notify the 
enrollee, the enrollee's designee, if applicable, and the person who has issued the valid 
prescription for the enrollee of its coverage decision within 72 hours or 2 business days, 
whichever is less, following receipt of the request.  A carrier that grants coverage under 
this paragraph must provide coverage of the drug for the duration of the prescription, 
including refills.  A prior authorization for a prescription is valid for the duration of the 
prescription, including refills, or one year, whichever is longer. A health plan may not 
require the renewal of a prior authorization more frequently than once every 5 years 
for a prescription that continues for more than one year. The prior authorization 
approval is valid from the date the enrollee receives notice of the approval and remains 
valid for a prescription drug prescribed by a provider regardless of a change in dosage.  
A utilization review entity may rescind the prior authorization approval for prescription 
drug doses that exceed limitations set by federal or state law, regulation or rule.
Sec. 3.  24-A MRSA §4311, sub-§1-B is enacted to read:
1-B.  Prescription coverage restriction prohibition; notice.  A health plan may not 
restrict coverage for a prescription that received prior authorization approval under a 
previous health plan within 90 days of enrollment in the new health plan by an enrollee 
who is stable on that health care service, as determined by a health care provider. The health 
plan must provide the enrollee with at least 90 days' notice prior to restricting coverage 
pursuant to this subsection.
SUMMARY
This bill requires that a prior authorization for health care services remain valid for the 
duration of the treatment or one year, whichever is longer. It prohibits a health care plan 
from requiring the renewal of a prior authorization more frequently than once every 5 years 
for treatment that is necessary for more than one year. It also prohibits a health care plan 
from restricting coverage for a health care service or a prescription that was approved under 
a previous health care plan within 90 days of enrollment in the new health care plan and 
requires a health care plan to provide at least 90 days' notice to an enrollee prior to 
restricting coverage of a previously approved health care service.