August 1, 2025 Bulletins SENATE BILL 39, ADD CLASSES TO PRIOR AUTHORIZATION DRUGS BULLETIN 2025-005 Senate Bill 39 (SB39) was signed into law by Governor Michelle Lujan Grisham on April 7, 2025, and became effective July 1, 2025. SB39 amends the Prior Authorization Act, NMSA 1978, Sections 59A-22B-2, 59A-22B-5, and 59A-22B-8 to include the following: removes prior-authorization and/or step therapy requirements for Food & Drug Administration (FDA) approved drugs used off-label for the treatment of rare diseases or conditions; requires coverage for these medications to be made pursuant to a medical necessity determination made by a health care professional from the same or similar practice specialty that typically manages the medical condition, procedure, or treatment under review; sets time frames for medical necessity determinations; and amended the definition for “prior authorization” and added new definitions to include “off label” and “rare disease or condition” in NMSA 1978, Section 59A-22B-2. To ensure equal application of the provisions of SB39 and the requirements with respect to health plan coverage, the New Mexico Office of Superintendent of Insurance (OSI) provides further clarification and directs every subject health plan to comply with the following: For complete bulletin content please see PDF below. SENATE BILL 39, ADD CLASSES TO PRIOR AUTHORIZATION DRUGS (PDF)
