Bulletin Addresses Changes to Drug Prior Authorization Requirements

August 12, 2025

On August 1, 2025, the New Mexico Office of the Superintendent of Insurance released Bulletin 2025-005 as a public reminder to health insurers of recent changes to the state’s Prior Authorization Act.

As background, on April 7, 2025, Gov. Lujan Grisham signed into law SB39, which amended the Prior Authorization Act by:

• Removing prior-authorization and/or step therapy requirements for Food and Drug Administration (FDA)-approved drugs used off-label for the treatment of rare diseases or conditions.
• Requiring coverage for these medications pursuant to a medical necessity determination made by a healthcare professional from the same or similar practice specialty that typically manages the medical condition, procedure, or treatment under review.
• Establishing time frames for medical necessity determinations (seven calendar days for standard determinations and 24 hours for emergency determinations).
• Amending the definition of “prior authorization” and adding new definitions to include “off label” and “rare disease or condition.”

The bulletin provides further clarification regarding the above changes to ensure consistent application by carriers.

Although the bulletin is directed at carriers, employers that sponsor fully insured plans issued in the state may also want to be aware of these recent amendments, which apply to policies issued on or after July 1, 2025.

Read more on Senate Bill 39, Add Classes to Prior Authorization Drugs – New Mexico OSI.