Prior Authorization in South Dakota
South Dakota enacted HB 1004 (2020) requiring step therapy override protections. Insurers must grant exceptions when the required drug is contraindicated, was tried, or is expected to be ineffective. SD provides external review for denied PA claims.
Key Facts About PA in South Dakota
- ✓ Step therapy override protections enacted in 2020
- ✓ External review available through the SD Division of Insurance
- ✓ PA decisions must be made within standard timeframes
- ✓ Avera Health Plans and Sanford Health Plan are major carriers
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in South Dakota
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these South Dakota carriers:
Avera Health PlansSanford Health PlanWellmark BCBS SDUnitedHealthcare