Prior Authorization in Florida
Florida enacted SB 1330 (2023) reforming PA requirements. The law mandates PA decisions within 7 days for standard requests and 72 hours for urgent requests. It also requires continuity of PA approvals when patients switch plans and limits PA denials to clinical peer reviewers with relevant specialty training.
Key Facts About PA in Florida
- ✓ Standard PA decisions required within 7 days; urgent within 72 hours
- ✓ PA denials must be made by a clinical peer reviewer with relevant specialty
- ✓ Continuity of PA approvals when switching plans
- ✓ Florida Office of Insurance Regulation oversees external review
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in Florida
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these Florida carriers:
Florida Blue (BCBS)UnitedHealthcareAetnaHumana