This bill amends existing laws related to prior authorization requests for medical care covered by health care insurers in Alaska. It introduces a new process for prior authorization that mandates health care insurers to establish a reasonable and efficient system that minimizes administrative burdens on providers. The bill specifies timelines for insurers to respond to prior authorization requests, requiring determinations within 72 hours for standard requests and 24 hours for expedited requests. It also outlines the conditions under which a prior authorization request is considered approved if the insurer fails to respond within the specified timeframes. Additionally, the bill requires insurers to maintain a prior authorization application programming interface to streamline the process and ensure compliance with federal interoperability standards.

Furthermore, the bill addresses step therapy protocols, particularly for patients with Stage 4 advanced metastatic cancer, ensuring that insurers cannot mandate step therapy for FDA-approved drugs. It establishes a clear process for requesting exceptions to step therapy protocols and requires insurers to provide detailed information regarding adverse determinations, including the appeals process. The bill also mandates annual reporting by health care insurers to ensure compliance with the new requirements and allows for penalties for noncompliance. Overall, the legislation aims to enhance transparency, efficiency, and patient access to necessary medical care while ensuring that health care providers have the necessary tools to navigate the prior authorization process effectively.

Statutes affected:
HB0144A, AM HB 144, introduced 03/21/2025: 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
HB0144B, AM CSHB 144(HSS), introduced 04/09/2025: 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