Colorado, Illinois, Maine, Maryland, Minnesota, Mississippi, Oklahoma, Vermont, Virginia and Wyoming have passed prior authorization laws this year, according to the report.
The AMA said the specifics of the laws vary by state, “but broadly speaking they aim to cut the growing volume of prior authorization requirements, reduce patient care delays, increase the data that must be publicly reported and improve transparency about which medications and procedures require prior authorization.”
Wyoming’s law created a gold-card program and also requires payers to respond to prior authorization requests within 72 hours for urgent situations and five calendar days for nonurgent situations, according to the report. The law provides a grace period where payers must honor previous prior authorizations when the patient switches plans.
Oklahoma’s law requires prior authorization procedures to be published on websites available to patients and providers. Those with chronic conditions must be notified no less than 60 days prior to changes that will affect them. If a prior authorization is denied, appeals must be reviewed by providers of the same or similar specialties. Payers must respond to urgent requests within 72 hours and within seven days for non-urgent requests.
Illinois’ law bans prior authorization for admission for inpatient psychiatric services, beginning in 2026. Payers will also be required to publish all services that require prior authorization on their website, and face stricter requirements to maintain an accurate provider network directory.
Massachusetts is another state that could pass a prior authorization reform bill this year, according to the report. The proposed legislation would require a patient’s new insurer to honor prescription drug prior authorizations from the previous health plan for at least 90 days after the patient enrolls. Additionally, if medications and treatments prescribed for chronic disease management receive prior authorization, the approval would need to remain valid for the length of the prescription, up to 1 year.
Last year, nine states and Washington, D.C., passed prior authorization reform laws, according to the report.
