23 CAR Part 143 — Prior Authorizations for Pain Medications for Terminal Illnesses

Chapter I

Subchapter B

Subpart 1

23 CAR § 143-101 Definitions {#sec-23-car-143-101 omnilex-key=us-ar-regs-official--title-23-part-143--23 CAR § 143-101}

23 CAR § 143-101. Definitions.

As used in this part:

(1) “Covered person” means a “covered person” as defined in Arkansas Code § 23-99-403(3);

(2) “Health benefit plan” means a “health benefit plan” as defined in Arkansas Code § 23-99-1103(7);

(3) “Healthcare insurer” means a “healthcare insurer” as defined in Arkansas Code § 23-99-1103(8);

(4) “Prescription pain medication” means any medication prescribed as treatment for pain;

(5) “Prior authorization” means “prior authorization” as defined in Arkansas Code § 23-99-1103(15);

(6) “Terminal illness” means an illness, a progressive disease, or an advanced disease state from which:

(A) There is no expectation of recovery; and

(B) Death as a result of the illness or disease is reasonably expected within six (6) months; and

(7) “Utilization review entity” means a “utilization review entity” as defined in Arkansas Code § 23-99-1103(21).

23 CAR § 143-102 Pain medication authorizations {#sec-23-car-143-102 omnilex-key=us-ar-regs-official--title-23-part-143--23 CAR § 143-102}

23 CAR § 143-102. Pain medication authorizations.

(a) If a prescription pain medication requires a prior authorization by a healthcare insurer or utilization review entity, a prior authorization for prescription pain medication shall not be denied to a covered person with a terminal illness by a healthcare insurer or utilization review entity.

(b) However, coverage for individual prescriptions may be subject to quantity limits and United States Food and Drug Administration approval as provided in the health benefit plan and may be monitored by the utilization review entity or healthcare insurer to limit drug diversion and abuse.