Prior Authorization in New Mexico
New Mexico enacted SB 337 (2019) establishing step therapy exception requirements. The law mandates exceptions when the required drug is contraindicated, was tried and failed, or is expected to be ineffective. NM requires timely PA decisions and provides external review.
Key Facts About PA in New Mexico
- ✓ Step therapy exception requirements codified in law
- ✓ PA decisions must be timely with expedited process available
- ✓ External review available through the NM Office of Superintendent of Insurance
- ✓ BCBS of New Mexico (HCSC) and Presbyterian Health Plan are major carriers
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in New Mexico
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these New Mexico carriers:
BCBS of New MexicoPresbyterian Health PlanUnitedHealthcareMolina