Senate committee hears SB20 to limit prior authorization for serious mental illness; sponsor to draft substitute

Senate Health and Public Affairs Committee on Friday considered Senate Bill 20, a proposal to exempt some medications for people with serious mental illness from prior‑authorization requirements and to make prior authorizations durable for multiple years.

Sponsor testimony traced prior authorization reforms since 2018 and said the bill adds ‘‘seriously mentally ill’’ to existing exemptions and would extend authorizations for up to three years at the request of the executive branch. ‘‘This is a prior authorization bill to exempt some categories from prior authorization,’’ the sponsor said, explaining changes recommended by the executive office and state agencies.

Industry witnesses urged caution. ‘‘Prior authorization is a necessary checkpoint, for preventing unnecessary, unsafe, and high cost, low value, care,’’ Brent Moore, a registered lobbyist for America’s Health Insurance Plans, told the committee. He argued the bill’s SMI definition goes beyond DSM‑5 and listed conditions such as ADHD, eating disorders and seasonal affective disorder that he said should not automatically remove prior authorization safeguards. Prime Therapeutics’ testimony noted that only about 6% of prescriptions currently require prior authorization and warned that a three‑year reauthorization window could leave patients on therapies that need annual monitoring.

Mental‑health advocates pushed back, saying faster access reduces barriers to care. ‘‘NAMI New Mexico stands in support of SB20,’’ said Gabrielle Dietrich, NAMI New Mexico’s executive director, adding that clinicians are best positioned to determine patient needs and that prior authorization can be an obstacle to timely care.

State agency witnesses described technical changes: Alana Dances, identifying herself as the state Medicaid director and a nurse practitioner, said the adopted amendment narrows the bill to adults because ‘‘there are times that there is safety reasons for prior authorization’’ in pediatric populations. Vierra Nakiva of the Office of Superintendent of Insurance said the amendment would allow OSI to assist members of IBAC contracting groups (state employees, retirees, Albuquerque Public Schools) with PBM complaints.

Committee members pressed the sponsor on the bill’s scope and the three‑year interval. Several senators said they would prefer a shorter reauthorization period and clearer definitions of ‘‘chronic conditions.’’ The sponsor said she would prepare a committee substitute incorporating a CMS list of chronic conditions, consider a one‑year interval, and negotiate implementation timing with insurers. The chair agreed to roll the bill over to allow a substitute to be drafted.

Next steps: sponsor to file a committee substitute with narrower definitions and revised timelines; the committee did not take a final vote on SB20 at this hearing.