The bill amends existing laws concerning prior authorization requests for medical care covered by health care insurers in Alaska, establishing a new process that requires insurers to create a reasonable and efficient system to reduce administrative burdens on providers. Insurers must respond to standard requests within 72 hours and expedited requests within 24 hours, with any inadequately addressed requests automatically considered approved. The legislation also mandates that insurers publicly disclose their prior authorization criteria, which must be based on peer-reviewed, evidence-based clinical review standards. Additionally, it addresses step therapy protocols for patients with Stage 4 advanced metastatic cancer, prohibiting insurers from requiring step therapy for FDA-approved drugs and ensuring a clear process for requesting exceptions.

The bill further clarifies the definition of "utilization review organization" to exclude health care insurers conducting utilization reviews for their own policies and introduces a provision allowing the director of the division of insurance to adopt necessary regulations for implementing the Act. The legislation mandates annual reporting by health care insurers to ensure compliance with the new requirements, including response times and transparency in prior authorization processes, with penalties for noncompliance. The bill specifies that Section 4 will take effect immediately, while the remaining provisions will be enforced starting January 1, 2027, allowing time for the establishment of the necessary regulatory framework.

Statutes affected:
SB0133A, AM SB 133, introduced 03/17/2025: 21.07.080, 21.07.005, 21.07.090, 21.07.100, 21.07.180, 21.07.110, 21.07.120, 21.07.130, 21.07.140, 21.07.150, 21.07.160, 21.07.170, 21.06.120, 21.06.230, 21.07.250
SB0133B, AM CSSB 133(L&C), introduced 04/04/2025: 21.07.080, 21.07.005, 21.07.090, 21.07.100, 21.07.180, 21.07.110, 21.07.120, 21.07.130, 21.07.140, 21.07.150, 21.07.160, 21.07.170, 21.06.120, 21.06.230, 21.07.250
SB0133Z, AM Enrolled SB 133, introduced 05/18/2025: 21.07.080, 21.07.005, 21.07.090, 21.07.100, 21.07.180, 21.07.110, 21.07.120, 21.07.130, 21.07.140, 21.07.150, 21.07.160, 21.07.170, 21.06.120, 21.06.230, 21.07.250