SB 39 expands New Mexico’s Prior Authorization Act by adding additional drug categories that are exempt from prior authorization and step therapy requirements. The bill specifically bars prior authorization for FDA-approved medications used to treat autoimmune disorders, cancer, rare diseases or conditions, and substance use disorders when a medical-necessity determination is made by a clinician in the same or similar specialty, with exceptions where a biosimilar, interchangeable biologic, or generic is available. It also prohibits step therapy for certain off-label medications used to treat rare diseases or conditions under the same medical-necessity standard.
The bill also updates the broader prior authorization framework for health insurers. It reinforces electronic submission and auto-adjudication requirements, requires prompt review and notice for denied requests, and preserves expedited timelines for urgent cases. For prescription drugs not on a plan formulary, insurers may continue to deny coverage electronically but must provide alternative formulary options and inform patients of exception and appeal rights. The act applies to policies and plans issued or renewed on or after July 1, 2025, across multiple insurance law chapters and health coverage arrangements.
Impact
SB 39 would amend Sections 59A-22B-2, 59A-22B-5, and 59A-22B-8 of the New Mexico Statutes Annotated, expanding the list of prescription drugs and conditions shielded from prior authorization and step therapy. It would affect health insurers, pharmacy benefit managers, health care providers, and covered persons by limiting utilization management for certain high-need therapies and by strengthening procedural requirements for prior authorization review, appeals, and expedited determinations. The bill applies prospectively to health plans entered into, offered, or issued on or after July 1, 2025.
Sentiment
The voting record indicates strong bipartisan support for the bill. It passed the Senate unanimously, 34-0, and later passed the House by a wide margin, 60-6. The absence of committee transcript material limits insight into detailed debate, but the overwhelming votes suggest broad agreement with the bill’s consumer-protection and access-to-care goals.
Contention
The main policy tension in SB 39 is between improving patient access to needed medications and preserving insurer tools for cost control and formulary management. Supporters are likely to favor the bill because it reduces delays for patients with serious conditions such as cancer, autoimmune disorders, substance use disorders, and rare diseases. Potential concerns would come from insurers and managed-care entities about reduced flexibility to use prior authorization and step therapy, especially where lower-cost biosimilars, interchangeable biologics, or generics are available and where the bill requires faster review and appeal processes.