Senate committee advances substitute to cut prior authorization for some serious mental-illness drugs

A Senate committee on Feb. 13 considered a committee substitute for Senate Bill 20 that would narrow prior-authorization requirements for medications prescribed to people the bill defines as having a serious mental illness. Sponsor remarks, expert testimony and public comment centered on whether easing prior authorization would improve medication continuity for people with schizophrenia and other persistent conditions or instead reduce clinical oversight and raise costs.

Sponsor presentation and key provisions

Sponsor Senator Stefanos presented the committee substitute as a targeted exception to prior authorization for drugs treating serious mental illness. The bill inserts a standardized definition for “serious mental illness” (drawing on CDC/DSM-5 and SAMHSA language), expands references to pharmacy-benefit managers and the interagency purchasing collaborative (IBAC), requires insurers to deem a prescription prior-authorization granted if the insurer does not act within three business days, and — for long-term chronic regimens — sets a renewable prior-authorization period the bill places at three years for continuing medication. The draft also includes a phased effective date provision (01/01/2027) for some provisions.

Support and testimony

Clinical and advocacy witnesses told the committee uninterrupted access to long-acting injectable antipsychotics and other maintenance medications reduces hospitalizations and supports community stability. Gloria Doherty of the New Mexico Nursing Association and nurse practitioners said delays in authorization can lead patients to “get lost to care.” Forensic psychologist Dr. Bronwyn Nieser, speaking for NAMI New Mexico, said the bill would ease medication management burdens on caregivers and clinicians.

Opposition and insurer concerns

Representatives for pharmacy-benefit managers and insurers urged caution. Pat Block of Otero Consulting (for Prime Therapeutics) and Brent Moore of America’s Health Insurance Plans said annual clinical review is an important safety checkpoint: patient conditions, comorbidities and medication safety profiles can change, they said, so a three-year authorization carries clinical risk. Moore also pointed to fiscal impacts cited in fiscal-impact reports, including estimated pharmacy savings that could be lost for certain plan sponsors.

Agency response

An OSI representative told the committee that with a more narrowly defined serious-mental-illness definition in the current draft, OSI did not expect significant premium increases. Keenan Ryan, representing the health-care authority and Medicaid medical leadership, said Medicaid historically used one-year renewals but that, after review, the authority was comfortable the three-year period in this draft would be safe for most members.

Committee action and procedural outcome

Following public testimony, the committee moved a procedural motion to record a formal “do not pass” on the underlying Senate Bill 20 while approving the Senate Tax, Business and Transportation committee substitute for the Senate Health and Public Affairs committee substitute. The chair recorded that, procedurally, the committee voted in a configuration that produced a 7–2 tally in favor of the substitute pathway (the committee recorded the procedural language and the 7–2 tally on the motion). The sponsor acknowledged remaining debate about the three-year vs. one-year renewal timeframe but noted the substitute incorporated many stakeholder-driven amendments.

What happens next

Because the committee approved the committee substitute pathway, the bill will proceed per committee rules to the next committee(s) noted on the record. No final statewide implementation or regulation details were decided in committee; sponsors and agencies said they expect additional review as the bill moves through remaining steps.