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Committee advances bill limiting prior authorization for certain services amid industry pushback
Summary
House Bill 570, addressing prior authorization and step-therapy rules for health plans, advanced from the committee after testimony from insurers, pharmacy benefit managers and patient advocates; opponents warned of cost impacts and urged more study while sponsors said the bill would speed patient access to care.
House Bill 570, a measure to restrict prior authorization and step-therapy requirements for certain covered services and prescription drugs, received divided testimony before the committee and a do-pass recommendation.
Sponsor remarks were presented by the floor leader on behalf of Representative Jennifer Jones. Supporters and opponents agreed on the need to reduce unnecessary delays in patient care, but disagreed on the proper statutory approach and the likely cost consequences.
Opponents included representatives of health insurers and pharmacy benefit managers. Brent Moore, registered lobbyist for America's Health Insurance Plans (AHIP), told the committee AHIP opposes the bill because prior authorization is a tool to ensure evidence-based care and control unnecessary spending. Jonathan Buxton of the Pharmaceutical Care Management Association said prior authorization helps limit unnecessary or low-value care; he told the panel that the American Medical Association estimates about 25% of medical spending may be unnecessary.
Insurers urged the committee to allow time to assess the impacts of recently enacted limits (for example, on chemotherapy and autoimmune drugs) and to consider compromise approaches such as "gold card" programs that exempt high-performing providers from frequent prior-authorizations. Marla Schoetz for Blue Cross Blue Shield of New Mexico said the industry is working with the New Mexico Medical Society on a gold-card compromise and asked the legislature to consider implementation experience before broad new prohibitions.
Supporters said prior authorization often delays care and imposes administrative burdens on clinicians and patients. Committee members asked about effects on premiums and program costs; sponsors said they did not have definitive premium-impact numbers in committee testimony and that further study might be required.
Committee action: Representative Zamora moved a do-pass recommendation, seconded by Representative Mejia. The committee approved the motion; the clerk announced the motion passed by a vote of 6 to 2.
Ending: The bill will move forward; committee members and stakeholders signaled the need for additional fiscal clarity and consideration of gold-card alternatives as the measure advances.
