PRIOR AUTHORIZATION & PRESCRIPTION DRUGS
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SB 20 — PRIOR AUTHORIZATION & PRESCRIPTION DRUGS
Last action — Signed
No card. One bill, free forever — alerts when it moves.
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✓Introduced
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✓In Committee
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✓Passed Senate
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✓Passed House
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✓To Executive
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6Enacted
This bill has been enacted into law. Introduced January 26, 2026. Enacted.
Signed by Governor Michelle Lujan Grisham (Democratic) on March 06, 2026.
Prognosis
Where this bill stands today.
Odds of enactment
HighHow often bills like it became law.
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Enacted
Current position in the legislative process.
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5 sponsors
5 primary, 0 co-sponsors signed on.
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Single-party support
Sponsorship is currently within one party (5 D).
Prognosis reads this bill's own signals — stage, sponsorship breadth, committee status, recorded votes and cross-state momentum. Odds come from a model trained on which bills have become law.
Bill Text
What changed in the latest version
374 added · 523 removedPlain-language change summary
The updated version of Bill SB 20 expands protections surrounding prior authorization for prescription medications. It specifically prohibits the requirement for prior authorization on certain drugs used to treat serious mental illnesses and limits such requirements for medications intended for chronic health conditions. This change is significant because it aims to improve access to essential medications for individuals with mental health issues and chronic illnesses, helping ensure they receive timely treatment without unnecessary delays.
SENATE TAX, BUSINESS AND TRANSPORTATION COMMITTEE SUBSTITUTE FOR SENATE HEALTH AND PUBLIC AFFAIRS COMMITTEE SUBSTITUTE FOR SENATE BILL 20 57TH LEGISLATURE -STATEOFNEWMEXICO- SECOND SESSION , 2026 4 6 8 10 AN ACT RELATING TO INSURANCE;
e t 17 w l n d 18 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
= = 19 a l SECTION 1.
Section 59A-22B-2 NMSA 1978 (being Laws 2019, i a e r 20 Chapter 187, Section 4, as amended) is amended to read:
a t m m 21 "59A-22B-2.
DEFINITIONS.--As used in the Prior d r e 22 Authorization Act:
c e s k 23 A.
"adjudicate" means to approve or deny a request e a n b 24 for prior authorization;
u [ B.
"auto-adjudicate" means to use technology and .233886.3 STBTC/SHPAC/SB 20 automation to make a near-real-time determination to approve, deny or pend a request for prior authorization;
"chronic maintenance drug" means a medication approved by the federal food and drug administration to be STBTC/SHPAC/SB 20 taken regularly for the treatment of chronic health Page 1 conditions;
[C.] E.
[D.] F.
"emergency care" means medical care, pharmaceutical benefits or related benefits to a covered person after the sudden onset of what reasonably appears to be a medical condition that manifests itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could be reasonably expected by a e t 17 reasonable layperson to result in jeopardy to a person's w l n d 18 health, serious impairment of bodily functions, serious = = 19 dysfunction of a bodily organ or part or disfigurement to a a l i a e r 20 person;
a t m m 21 [E.] G.
"health benefits plan" means a policy, d r e 22 contract, certificate or agreement, entered into, offered or c e s k 23 issued by a health insurer to provide, deliver, arrange for, e a n b 24 pay for or reimburse any of the costs of medical care, u [ pharmaceutical benefits or related benefits;
.233886.3 - 2 - STBTC/SHPAC/SB 20 [F.] H.
[G.] I.
[H.]STBTC/SHPAC/SB 20 Page 2 J.
[I.] K.
e t 17 [J.] L.
"medical necessity" means health care w l n d 18 services determined by a health care provider, in consultation = = 19 with the health insurer, to be appropriate or necessary a l i a e r 20 according to:
a t m m 21 (1) applicable, generally accepted principles d r e 22 and practices of good medical care;
c e s k 23 (2) practice guidelines developed by the e a n b 24 federal government or national or professional medical u [ societies, boards or associations;
or .233886.3 - 3 - STBTC/SHPAC/SB 20 (3) applicable clinical protocols or practice guidelines developed by the health insurer consistent with federal, national and professional practice guidelines, which shall apply to the diagnosis, direct care and treatment of a physical or behavioral health condition, illness, injury or disease;
[K.] M.
"medical peer review" means review by a health STBTC/SHPAC/SB 20 Page 3 care professional from the same or similar practice specialty that typically manages the medical condition, procedure or treatment under review for prior authorization;
[L.] N.
"off-label" means a federal food and drug administration-approved medication that does not have a federal food and drug administration-approved indication for a specific condition or disease but is prescribed to a covered person because there is sufficient clinical evidence for a prescribing clinician to reasonably consider the medication to be medically e t 17 necessary to treat the covered person's condition or disease;
w l n d 18 [M.] O.
"office" means the office of superintendent = = 19 of insurance;
a l i a e r 20 [N.] P.
"pend" means to hold a prior authorization a t m m 21 request for further clinical review;
d r e 22 [O.] Q.
"pharmacy benefits manager" means [an agent c e s k 23 responsible for handling prescription drug benefits for a e a n b 24 health insurer] a person licensed by the superintendent as a u [ pharmacy benefits manager pursuant to the provisions of the .233886.3 - 4 - STBTC/SHPAC/SB 20 Pharmacy Benefits Manager Regulation Act that has a direct contract with an entity subject to the Health Care Purchasing Act;
[P.] R.
"prior authorization" means a voluntary or mandatory pre-service determination, including a recommended clinical review, that a health insurer makes regarding a covered person's eligibility for health care services, based on medical necessity, the appropriateness of the site of STBTC/SHPAC/SB 20 Page 4 services and the terms of the covered person's health benefits plan;
[and Q.] S.
"Serious mental illness" e t 17 includes major depression, schizophrenia, schizoaffective w l n d 18 disorder, bipolar disorder, obsessive-compulsive disorder, = = 19 panic disorder, posttraumatic stress disorder and borderline a l i a e r 20 personality disorder." a t m m 21 SECTION 2.
Section 59A-22B-4 NMSA 1978 (being Laws 2019, d r e 22 Chapter 187, Section 6) is amended to read:
Show all 89 changed lines (49 more)
c e s k 23 "59A-22B-4.
DUTIES OF OFFICE--PRESCRIBING PENALTIES.-- e a n b 24 A.
The office shall standardize and streamline the u [ prior authorization process across all health insurers.
.233886.3 - 5 - STBTC/SHPAC/SB 20 B.
provided that the uniform prior authorization form shall conform to the requirements established for medicare and medicaid medical and pharmacy STBTC/SHPAC/SB 20 Page 5 prior authorization requests.
By September 1, 2019, and each September 1 e t 17 thereafter, the office shall provide an annual written report w l n d 18 to the governor and the legislature to include, at a minimum:
= = 19 (1) prior authorization data for each health a l i a e r 20 insurer and pharmacy benefits manager individually and for a t m m 21 health insurers collectively;
d r e 22 (2) the number and nature of complaints c e s k 23 against individual health insurers and pharmacy benefits e a n b 24 managers for failure to follow the Prior Authorization Act;
and u [ (3) actions taken by the office, including the .233886.3 - 6 - STBTC/SHPAC/SB 20 imposition of fines, against individual health insurers and pharmacy benefits managers to enforce compliance with the Prior Authorization Act.
Section 59A-22B-5 NMSA 1978 (being Laws STBTC/SHPAC/SB 20 Page 6 2019, Chapter 187, Section 7, as amended) is amended to read:
(2) establish and maintain an electronic e t 17 portal system for:
w l n d 18 (a) the secure electronic transmission = = 19 of prior authorization requests on a twenty-four-hour, seven-seven-day-a-week a l i a e r 20 day-a-week basis, for medical care, pharmaceutical benefits or a t m m 21 related benefits;
and d r e 22 (b) auto-adjudication of prior c e s k 23 authorization requests;
e a n b 24 (3) provide an electronic receipt to the u [ health care provider and assign a tracking number to the health .233886.3 - 7 - STBTC/SHPAC/SB 20 care provider for the health care provider's use in tracking the status of the prior authorization request, regardless of whether or not the request is tracked electronically, through a call center or by facsimile;
(4) auto-adjudicate all electronically transmitted prior authorization requests to approve or pend a STBTC/SHPAC/SB 20 Page 7 request for benefits;
(1) an adjudication shall be made within twenty-four hours, or shall be deemed granted if not made e t 17 within twenty-four hours, when a covered person's health care w l n d 18 professional requests an expedited prior authorization and = = 19 submits to the health insurer or pharmacy benefits manager a a l i a e r 20 statement that, in the health care professional's opinion that a t m m 21 is based on reasonable medical probability, delay in the d r e 22 treatment for which prior authorization is requested could:
c e s k 23 (a) seriously jeopardize the covered e a n b 24 person's life or overall health;
u [ (b) affect the covered person's ability .233886.3 - 8 - STBTC/SHPAC/SB 20 to regain maximum function;
and (2) the adjudication time line shall commence only when the health insurer or pharmacy benefits manager receives all necessary and relevant documentation STBTC/SHPAC/SB 20 Page 8 supporting the prior authorization request.
[After December 31, 2020] An insurer or a pharmacy benefits manager may automatically deny a covered person's prior authorization request that is electronically submitted and that relates to a prescription drug that is not on the covered person's health benefits plan formulary;
Upon denial of a covered person's prior e t 17 authorization request based on a finding that a prescription w l n d 18 drug is not on the covered person's health benefits plan = = 19 formulary, a health insurer or pharmacy benefits manager shall a l i a e r 20 notify the person of the denial and include in a conspicuous a t m m 21 manner information regarding the person's right to initiate a d r e 22 drug formulary exception request and the process to file a c e s k 23 request for an exception to the denial.
e a n b 24 E.
An auto-adjudicated prior authorization request u [ based on medical necessity that is pended or denied shall be .233886.3 - 9 - STBTC/SHPAC/SB 20 reviewed by a health care professional who has knowledge or consults with a specialist who has knowledge of the medical condition or disease of the covered person for whom the authorization is requested.
If the request is denied after review by a health care professional, STBTC/SHPAC/SB 20 Page 9 notice of the denial shall be provided to the covered person and covered person's provider with the grounds for the denial and a notice of the right to appeal and describing the process to file an appeal.
A health insurer or pharmacy benefits manager shall have in place policies and procedures for annual review e t 17 of its prior authorization practices to validate that the prior w l n d 18 authorization requirements advance the principles of lower cost = = 19 and improved quality, safety and service.
a l i a e r 20 H.
The office shall establish by rule protocols and a t m m 21 criteria pursuant to which a covered person or a covered d r e 22 person's health care professional may request expedited c e s k 23 independent review of an expedited prior authorization request e a n b 24 made pursuant to Subsection B of this section following medical u [ peer review of a prior authorization request pursuant to the .233886.3 - 10 - STBTC/SHPAC/SB 20 Prior Authorization Act." SECTION 4.
PRIOR AUTHORIZATION FOR PRESCRIPTION DRUGS OR STEP THERAPY FOR CERTAIN CONDITIONS PROHIBITED.-- STBTC/SHPAC/SB 20 Page 10 A.
Medical necessity determinations shall be automatically e t 17 approved within [seven] three business days for standard w l n d 18 determinations and twenty-four hours for emergency = = 19 determinations when a delay in treatment could:
a l i a e r 20 (1) seriously jeopardize a covered person's a t m m 21 life or overall health;
d r e 22 (2) affect a covered person's ability to c e s k 23 regain maximum function;
or e a n b 24 (3) subject a covered person to severe and u [ intolerable pain.
.233886.3 - 11 - STBTC/SHPAC/SB 20 B.
A health insurer or pharmacy benefits manager shall not impose step therapy requirements before authorizing coverage for medication approved by the federal food and drug administration that is prescribed for the treatment of an autoimmune disorder, cancer, a serious mental illness or a STBTC/SHPAC/SB 20 Page 11 substance use disorder, 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, except in cases in which a biosimilar, interchangeable biologic or generic version is available.
e t 17 C.
A health insurer or pharmacy benefits manager w l n d 18 shall not impose step therapy requirements before authorizing = = 19 coverage for an off-label medication that is prescribed for the a l i a e r 20 treatment of a rare disease or condition, pursuant to a medical a t m m 21 necessity determination made by a health care professional from d r e 22 the same or similar practice specialty that typically manages c e s k 23 the medical condition, procedure or treatment under review, e a n b 24 except in cases in which a biosimilar, interchangeable biologic u [ or generic version is available.
Medical necessity .233886.3 - 12 - STBTC/SHPAC/SB 20 determinations shall be automatically approved within [seven] three business days for standard determinations and twenty-four hours for emergency determinations when a delay in treatment could:
STBTC/SHPAC/SB 20 Page 12 (1) seriously jeopardize a covered person's life or overall health;
(1) the prior authorization was obtained based e t 17 on fraud or misrepresentation;
w l n d 18 (2) final action by the federal food and drug = = 19 administration, other regulatory agencies or the drug a l i a e r 20 manufacturer:
a t m m 21 (a) removes the chronic maintenance drug d r e 22 from the market;
c e s k 23 (b) limits use of the chronic e a n b 24 maintenance drug in a manner that affects the prior u [ authorization;
or .233886.3 - 13 - STBTC/SHPAC/SB 20 (c) communicates a patient safety issue that would affect the prior authorization;
(3) a generic equivalent or drug that is biosimilar to the chronic maintenance drug is added to the STBTC/SHPAC/SB 20 Page 13 health insurer's or pharmacy benefits manager's drug formulary;
e t 17 B.
w l n d 18 C.
= = 19 D.
or a l i a e r 20 E.
aSTBTC/SHPAC/SB t20 mPage m 21 - 14 -25 d r e 22 c e s k 23 e a n b 24 u [ .233886.3
Show all 89 changed rows (49 more)
View plain text versions (4)
- Final Version View text Current pdf
- Substitute CT substitute pdf
- Substitute PA substitute pdf
- Introduced introduced version pdf
AI-generated reading aid from the bill's amendatory text — verify against the official bill.
This bill amends existing law to enhance prior authorization processes for prescription drugs, particularly targeting treatments for serious mental illness and chronic health conditions.
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Section 59A-22B-4
the imposition of fines, against individual health insurers→ the imposition of fines, against individual health insurers and pharmacy benefits managersThis change expands the enforcement of penalties to include pharmacy benefits managers.
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Section 59A-22B-5
Prior authorization shall be deemed granted for prescription drug determinations not made within three business days, and for all other determinations not made within seven days;
This establishes a clear timeline for prior authorization grant for prescription drugs.
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Section 59A-22B-5
An insurer or a pharmacy benefits manager may automatically deny a covered person's prior authorization request that is electronically submitted and that relates to a prescription drug that is not on the covered person's health benefits plan formulary;
This allows for automatic denial of prior authorization based on formulary status.
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Section 59A-22B-5
When a health care professional requests an expedited prior authorization, it shall be deemed granted if not adjudicated within twenty-four hours;
This accelerates the approval process for urgent health care requests.
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Section 59A-22B-5
Upon denial of a covered person's prior authorization request based on a finding that a prescription drug is not on the covered person's health benefits plan formulary, a health insurer or pharmacy benefits manager shall notify the person of the denial and include in a conspicuous manner information regarding the person's right to initiate a drug formulary exception request;
This ensures transparency regarding denial notifications and options for patients.
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Section 59A-22B-5
The health care professional shall make a final determination within a time frame established by law, in consultation with specialists;
This mandates further review by specialists for denied prior authorization requests, ensuring more thorough decisions.
Action History
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Signed
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passed House
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DO PASS committee report adopted
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Sent to House Health & Human Services Committee
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passed Senate
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DO NOT PASS, replaced with committee substitute
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DO NOT PASS, replaced with committee substitute
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germane
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Sent to Senate Committees' Committee & Senate Health and Public Affairs Committee & Senate Tax, Business and Transportation Committee
Sponsors
- Elizabeth "Liz" Thomson · Primary
- Reena Szczepanski · Primary
- Linda M. López · Primary
- Elizabeth "Liz" Stefanics · Primary
- Martin Hickey · Primary
Sponsorship breakdown
Export CSV (upgrade) →5 sponsors · 0 co-sponsors · 107 not signed on
Sponsors (5)
- Elizabeth "Liz" Thomson Democrat
- Reena Szczepanski Democrat
- Linda M. López Democrat
- Elizabeth "Liz" Stefanics Democrat
- Martin Hickey Democrat
Co-sponsors (0)
None.
Not signed on (107)
107 members have not signed on to this bill.
Show all 107 →"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.
Subjects
Frequently asked questions
- Who sponsors SB 20?
- SB 20 is sponsored by Elizabeth "Liz" Thomson (Democrat), Reena Szczepanski (Democrat), Linda M. López (Democrat), Elizabeth "Liz" Stefanics (Democrat), and Martin Hickey (Democrat).
- What is the current status of SB 20?
- This bill has been enacted into law. Introduced January 26, 2026. Enacted.
- Where can I track SB 20?
- Track SB 20 free on One Click Politics — get push/email alerts when it moves.
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