AK
Alaska Senate Bill SB133

Alaska 2025-2026 Regular Session

Alaska Senate Bill SB133 Compare Versions

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2-SB0133B -1- CSSB 133(L&C)
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10-CS FOR SENATE BILL NO. 133(L&C)
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11+ SENATE BILL NO. 133
1112
1213 IN THE LEGISLATURE OF THE STATE OF ALASKA
1314
1415 THIRTY-FOURTH LEGISLATURE - FIRST SESSION
1516
1617 BY THE SENATE LABOR AND COMMERCE COMMITTEE
1718
18-Offered: 4/4/25
19-Referred: Finance
19+Introduced: 3/17/25
20+Referred: Labor and Commerce, Finance
2021
21-Sponsor(s): SENATE LABOR AND COMMERCE COMMITTEE
22+
2223 A BILL
2324
2425 FOR AN ACT ENTITLED
2526
2627 "An Act relating to prior authorization requests for medical care covered by a health 1
2728 care insurer; relating to a prior authorization application programming interface; 2
2829 relating to step therapy; and providing for an effective date." 3
2930 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 4
3031 * Section 1. AS 21.07.080 is amended to read: 5
3132 Sec. 21.07.080. Religious nonmedical providers. AS 21.07.005 - 21.07.090
3233 6
3334 [THIS CHAPTER] may not be construed to 7
3435 (1) restrict or limit the right of a health care insurer to include services 8
3536 provided by a religious nonmedical provider as medical care services covered by the 9
3637 health care insurance policy; 10
3738 (2) require a health care insurer, when determining coverage for 11
3839 services provided by a religious nonmedical provider, to 12
3940 (A) apply medically based eligibility standards; 13
40-(B) use health care providers to determine access by a covered 14 34-LS0470\I
41-CSSB 133(L&C) -2- SB0133B
41+(B) use health care providers to determine access by a covered 14 34-LS0470\N
42+SB 133 -2- SB0133A
4243 New Text Underlined [DELETED TEXT BRACKETED]
4344
4445 person; 1
4546 (C) use health care providers in making a decision on an 2
4647 internal or external appeal; or 3
4748 (D) require a covered person to be examined by a health care 4
4849 provider as a condition of coverage; or 5
4950 (3) require a health care insurance policy to exclude coverage for 6
5051 services provided by a religious nonmedical provider because the religious 7
5152 nonmedical provider is not providing medical or other data required from a health care 8
5253 provider if the medical or other data is inconsistent with the religious nonmedical 9
5354 treatment or nursing care being provided. 10
5455 * Sec. 2. AS 21.07 is amended by adding new sections to read: 11
5556 Article 2. Prior Authorizations. 12
5657 Sec. 21.07.100. Prior authorization requests. (a) A health care insurer 13
5758 offering a health plan issued or renewed on or after January 1, 2027, shall designate a 14
5859 prior authorization process that complies with the standards for prior authorizations for 15
5960 medical care and prescription drugs in AS 21.07.100 - 21.07.180. The process must be 16
6061 reasonable and efficient and minimize administrative burdens on health care providers 17
6162 and facilities. 18
6263 (b) If a health care provider submits a prior authorization request that contains 19
6364 the information necessary to make a determination, a health care insurer shall make a 20
6465 determination and notify the provider of the decision within 21
6566 (1) 72 hours after receiving a standard request submitted by a method 22
6667 other than facsimile; 23
6768 (2) 72 hours, excluding weekends, after receiving a standard request 24
6869 submitted by facsimile; or 25
6970 (3) 24 hours after receiving an expedited request. 26
7071 (c) If a health care provider submits a prior authorization request that does not 27
7172 contain the information necessary to make a determination, the health care insurer 28
7273 shall request specific additional information from the covered person's health care 29
7374 provider within 30
74-(1) one calendar day after receiving an expedited request; or 31 34-LS0470\I
75-SB0133B -3- CSSB 133(L&C)
75+(1) one calendar day after receiving an expedited request; or 31 34-LS0470\N
76+SB0133A -3- SB 133
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7879 (2) three calendar days after receiving a standard request. 1
7980 (d) If a health care insurer determines that the information provided by a 2
8081 health care provider is not sufficient to make a determination under (b) of this section, 3
8182 the health care insurer may request additional information. The health care insurer 4
8283 may establish a due date of not less than five nor more than 14 working days after 5
8384 receiving the prior authorization request by which the additional information must be 6
8485 submitted. The health care insurer must notify the health care provider and covered 7
8586 person of the due date along with the request for additional information and specify 8
8687 the additional information needed to complete the request. 9
8788 (e) A health care insurer that receives a prior authorization request from a 10
8889 health care provider shall provide to the health care provider confirmation of receipt 11
8990 that shows the date and time the request was received by the health care insurer. 12
9091 (f) A prior authorization request submitted under this section is considered 13
9192 approved if the health care insurer fails to provide a written denial, approval, or 14
9293 request for additional information within the time specified under this section. 15
9394 Sec. 21.07.110. Prior authorization standards. (a) A health care insurer shall 16
9495 make its most current prior authorization standards available to a covered person and 17
9596 health care provider on the health care insurer's Internet website, including 18
9697 information or documentation to be submitted by the covered person or health care 19
9798 provider or facility. If the health care insurer provides a portal, the insurer shall also 20
9899 make the prior authorization standards available on the portal. A health care insurer 21
99100 shall describe the standards in detailed, easily understood language. 22
100101 (b) A health care insurer's prior authorization standards must include prior 23
101102 authorization requirements used by the insurer and by the insurer's utilization review 24
102103 organizations. The prior authorization requirements must be based on peer-reviewed, 25
103104 evidence-based clinical review criteria and be consistently applied by all sources, 26
104105 including utilization review organizations, to avoid discrepancies or conflicts. The 27
105106 health care insurer shall evaluate and, if necessary, update the clinical review criteria 28
106107 at least annually. 29
107108 (c) If the prior authorization standards published by the heal
108109 th care insurer 30
109-differ from those published by the health care insurer's utilization review organization, 31 34-LS0470\I
110-CSSB 133(L&C) -4- SB0133B
110+differ from those published by the health care insurer's utilization review organization, 31 34-LS0470\N
111+SB 133 -4- SB0133A
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113114 the health care insurer shall use the prior authorization standard most favorable to the 1
114115 covered person. 2
115116 (d) A health care insurer shall indicate on its Internet website, for each service 3
116117 subject to prior authorization, 4
117118 (1) whether a standardized electronic prior authorization request 5
118119 transaction process is available; and 6
119120 (2) the date the prior authorization requirement 7
120121 (A) became effective for a policy issued or delivered in this 8
121122 state; and 9
122123 (B) was first listed on the health care insurer's Internet website. 10
123-Sec. 21.07.120. Peer review of prior authorization request. (a) A health care 11
124-insurer shall establish a process for a health care provider to request a clinical peer 12
125-review of a prior authorization request. 13
126-(b) A peer reviewer must have relevant clinical expertise in the specialty area 14
127-or be of an equivalent specialty as the health care provider submitting the prior 15
128-authorization request. A peer reviewer shall attest, in writing or electronically, that the 16
129-reviewer has personally reviewed and considered all medical notes and relevant 17
130-clinical information submitted as part of the prior authorization request. 18
131-(c) A health care insurer shall provide to a health care provider at the 19
132-provider's request the qualifications of a peer reviewer issuing an adverse decision on 20
133-a prior authorization request, including the specialty and relevant board certifications 21
134-of the peer reviewer. 22
135-Sec. 21.07.130. Period of validity of prior authorization. (a) A prior 23
136-authorization for a chronic condition is valid for a period of not less than 12 months 24
137-while the covered person remains covered by the health care policy. If the treatment 25
138-plan for a chronic condition is unchanged and the covered person's health care 26
139-provider submits to the health care insurer certification of compliance with the current 27
140-treatment plan, the health care insurer shall automatically renew the prior 28
141-authorization approval for the chronic condition for an additional 12-month period. 29
142-(b) Except for a prior authorization for a chronic condition subject to (a) of 30
143-this section, a prior authorization is valid for a period of 90 calendar days or a duration 31 34-LS0470\I
144-SB0133B -5- CSSB 133(L&C)
124+(e) If the prior authorization requirement is terminated, a health care insurer 11
125+shall indicate on its Internet website the date the prior authorization requirement was 12
126+removed for a policy issued or delivered in this state. 13
127+Sec. 21.07.120. Peer review of prior authorization request. (a) A health care 14
128+insurer shall establish a process for a health care provider to request a clinical peer 15
129+review of a prior authorization request. 16
130+(b) A peer reviewer must have relevant clinical expertise in the specialty area 17
131+or be of an equivalent specialty as the health care provider submitting the prior 18
132+authorization request. A peer reviewer shall attest, in writing or electronically, that the 19
133+reviewer has personally reviewed and considered all medical notes and relevant 20
134+clinical information submitted as part of the prior authorization request. 21
135+(c) A health care insurer shall provide to a health care provider at the 22
136+provider's request the qualifications of a peer reviewer issuing an adverse decision on 23
137+a prior authorization request, including the specialty and relevant board certifications 24
138+of the peer reviewer. 25
139+Sec. 21.07.130. Period of validity of prior authorization. (a) A prior 26
140+authorization for a chronic condition is valid for a period of not less than 12 months 27
141+while the covered person remains covered by the health care policy. If the treatment 28
142+plan for a chronic condition is unchanged and the covered person's health care 29
143+provider submits to the health care insurer certification of compliance with the current 30
144+treatment plan, the health care insurer shall automatically renew the prior 31 34-LS0470\N
145+SB0133A -5- SB 133
145146 New Text Underlined [DELETED TEXT BRACKETED]
146147
147-that is clinically appropriate, whichever is longer. If a health care insurer intends to 1
148-implement a new prior authorization requirement or restriction, or amend an existing 2
149-requirement or restriction, the health care insurer shall provide a participating health 3
150-care provider written notice of the new or amended requirement or restriction not less 4
151-than 60 days before the requirement or restriction is implemented. The health care 5
152-insurer shall post notice on the health care insurer's public facing, accessible Internet 6
153-website not less than 60 days before implementation of the requirement or restriction. 7
154-If a health care provider agrees in advance to receive notices electronically, the written 8
155-notice may be provided in an electronic format. The health care insurer may not 9
156-implement a new or amended requirement until the Internet websites of both the health 10
157-care insurer and the utilization review organization have been updated to reflect the 11
158-new or amended requirement or restriction. 12
159-Sec. 21.07.140. Adverse determinations. If a health care insurer makes an 13
160-adverse prior authorization determination, the health care insurer shall notify the 14
161-covered person and the covered person's health care provider and provide each 15
162-(1) a clear explanation of the reasons for the adverse determination, 16
163-including the specific evidence-based reasons and criteria used to make the 17
164-determination and a description of any specific missing or insufficient information that 18
165-contributed to the adverse determination; 19
166-(2) a statement of the covered person's right to appeal the adverse 20
167-determination; 21
168-(3) instructions on how to file an appeal, including a clear explanation 22
169-of the appeals process, appeal timeline, and the direct telephone number and electronic 23
170-and physical mailing addresses for appeals. 24
171-Sec. 21.07.150. Prior authorization application programming interface. A 25
172-health care insurer shall maintain a prior authorization application programming 26
173-interface that automates the process for health care providers to determine whether a 27
174-prior authorization is required for medical care, identify prior authorization 28
175-information and documentation requirements, and facilitate the exchange of prior 29
176-authorization requests and determinations from its electronic health records or practice 30
177-management system. The application programming interface must be consistent with 31 34-LS0470\I
178-CSSB 133(L&C) -6- SB0133B
148+authorization approval for the chronic condition for an additional 12-month period. 1
149+(b) Except for a prior authorization for a chronic condition subject to (a) of 2
150+this section, a prior authorization is valid for a period of 90 calendar days or a duration 3
151+that is clinically appropriate, whichever is longer. If a health care insurer intends to 4
152+implement a new prior authorization requirement or restriction, or amend an existing 5
153+requirement or restriction, the health care insurer shall provide a participating health 6
154+care provider written notice of the new or amended requirement or restriction not less 7
155+than 60 days before the requirement or restriction is implemented. The health care 8
156+insurer shall post notice on the health care insurer's public facing, accessible Internet 9
157+website not less than 60 days before implementation of the requirement or restriction. 10
158+If a health care provider agrees in advance to receive notices electronically, the written 11
159+notice may be provided in an electronic format. The health care insurer may not 12
160+implement a new or amended requirement until the Internet websites of both the health 13
161+care insurer and the utilization review organization have been updated to reflect the 14
162+new or amended requirement or restriction. 15
163+Sec. 21.07.140. Adverse determinations. If a health care insurer makes an 16
164+adverse prior authorization determination, the health care insurer shall notify the 17
165+covered person and the covered person's health care provider and provide each 18
166+(1) a clear explanation of the reasons for the adverse determination, 19
167+including the specific evidence-based reasons and criteria used to make the 20
168+determination and a description of any specific missing or insufficient information that 21
169+contributed to the adverse determination; 22
170+(2) a statement of the covered person's right to appeal the adverse 23
171+determination; 24
172+(3) instructions on how to file an appeal, including a clear explanation 25
173+of the appeals process, appeal timeline, and the direct telephone number and electronic 26
174+and physical mailing addresses for appeals. 27
175+Sec. 21.07.150. Prior authorization application programming interface. A 28
176+health care insurer shall maintain a prior authorization application programming 29
177+interface that automates the process for health care providers to determine whether a
178+30
179+prior authorization is required for medical care, identify prior authorization 31 34-LS0470\N
180+SB 133 -6- SB0133A
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181-the technical standards and implementation dates established in the Centers for 1
182-Medicare and Medicaid Services rules on interoperability and patient access. The 2
183-application programming interface must support the exchange of prior authorization 3
184-requests and determinations for medical care and prescription drugs, including 4
185-information on covered alternative prescription drugs. The application programming 5
186-interface must indicate that a prior authorization denial, an authorization of medical 6
187-care less intensive than the medical care included in the original request, or an 7
188-authorization of a prescription drug other than the one included in the original prior 8
189-authorization request is an adverse benefit determination and is subject to the health 9
190-care insurer's grievance and appeal process under AS 21.07.005. 10
191-Sec. 21.07.160. Step therapy restrictions and exceptions. (a) A health care 11
192-insurer that provides coverage under a health care insurance policy for the treatment of 12
193-Stage 4 advanced metastatic cancer may not limit or exclude coverage under the health 13
194-benefit plan for a drug that is approved by the United States Food and Drug 14
195-Administration and that is on the insurer's prescription drug formulary by mandating 15
196-that a covered person with Stage 4 advanced metastatic cancer undergo step therapy if 16
197-the use of the approved drug is an approved indication by the United States Food and 17
198-Drug Administration or on the National Comprehensive Cancer Network Drugs and 18
199-Biologics Compendium as an indication for the treatment of Stage 4 advanced 19
200-metastatic cancer consistent with Category 1 or Category 2A of evidence and 20
201-consensus or peer-reviewed medical literature. 21
202-(b) If coverage of a prescription drug for the treatment of any medical 22
203-condition is restricted by a health care insurer or utilization review organization 23
204-because of a step therapy protocol, the health care insurer or utilization review 24
205-organization must provide a covered person and the covered person's health care 25
206-provider with access to a clear, convenient, and readily accessible process for 26
207-requesting an exception to application of the step therapy protocol. A health care 27
208-insurer or utilization review organization may use its existing medical exceptions 28
209-process to satisfy this requirement. The health care insurer or utilization review 29
210-organization shall disclose the process to the covered person and the covered person's 30
211-health care provider, along with the information needed to process the request, and 31 34-LS0470\I
212-SB0133B -7- CSSB 133(L&C)
183+information and documentation requirements, and facilitate the exchange of prior 1
184+authorization requests and determinations from its electronic health records or practice 2
185+management system. The application programming interface must be consistent with 3
186+the technical standards and implementation dates established in the Centers for 4
187+Medicare and Medicaid Services rules on interoperability and patient access. The 5
188+application programming interface must support the exchange of prior authorization 6
189+requests and determinations for medical care and prescription drugs, including 7
190+information on covered alternative prescription drugs. The application programming 8
191+interface must indicate that a prior authorization denial, an authorization of medical 9
192+care less intensive than the medical care included in the original request, or an 10
193+authorization of a prescription drug other than the one included in the original prior 11
194+authorization request is an adverse benefit determination and is subject to the health 12
195+care insurer's grievance and appeal process under AS 21.07.005. 13
196+Sec. 21.07.160. Step therapy restrictions and exceptions. (a) A health care 14
197+insurer that provides coverage under a health care insurance policy for the treatment of 15
198+Stage 4 advanced metastatic cancer may not limit or exclude coverage under the health 16
199+benefit plan for a drug that is approved by the United States Food and Drug 17
200+Administration and that is on the insurer's prescription drug formulary by mandating 18
201+that a covered person with Stage 4 advanced metastatic cancer undergo step therapy if 19
202+the use of the approved drug is an approved indication by the United States Food and 20
203+Drug Administration or on the National Comprehensive Cancer Network Drugs and 21
204+Biologics Compendium as an indication for the treatment of Stage 4 advanced 22
205+metastatic cancer consistent with Category 1 or Category 2A of evidence and 23
206+consensus or peer-reviewed medical literature. 24
207+(b) If coverage of a prescription drug for the treatment of any medical 25
208+condition is restricted by a health care insurer or utilization review organization 26
209+because of a step therapy protocol, the health care insurer or utilization review 27
210+organization must provide a covered person and the covered person's health care 28
211+provider with access to a clear, convenient, and readily accessible process for 29
212+requesting an exception to application of the step therapy prot
213+ocol. A health care 30
214+insurer or utilization review organization may use its existing medical exceptions 31 34-LS0470\N
215+SB0133A -7- SB 133
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215-make the process available on the health care insurer's Internet website for the plan. 1
216-(c) A health care insurer or utilization review organization shall grant a step 2
217-therapy exception under this section if the covered person has tried the prescription 3
218-drugs required under the step therapy protocol while under a current or previous health 4
219-care insurance policy or health benefit plan, including a health care insurance policy or 5
220-health benefit plan offered by a different insurer or payor, and the prescription drugs 6
221-were discontinued because of lack of efficacy or effectiveness, diminished effect, or 7
222-an adverse event or if the covered person's health care provider attests that coverage of 8
223-the prescribed prescription drug is necessary to save the life of the covered person. 9
224-Use of drug samples from a pharmacy may not be considered trial and failure of a 10
225-preferred prescription drug required under a step therapy protocol. 11
226-(d) The health care insurer or utilization review organization may request 12
227-relevant information from the covered person or the covered person's health care 13
228-provider to support a step therapy exception request made under this section. Upon 14
229-granting a step therapy exception request, the health care insurer or utilization review 15
230-organization shall authorize dispensation of and coverage for the prescription drug 16
231-prescribed by the covered person's health care provider if the drug is a covered drug 17
232-under the health care insurance policy. 18
233-(e) This section may not be construed to prevent a 19
234-(1) health care insurer or utilization review organization from requiring 20
235-a covered person to try a generic equivalent or other brand name drug before 21
236-providing coverage for the requested prescription drug; or 22
237-(2) health care provider from prescribing a prescription drug that the 23
238-provider determines is medically appropriate. 24
239-Sec. 21.07.170. Annual report. A health care insurer shall submit an annual 25
240-report to the director, on a form prescribed by the director, detailing compliance with 26
241-the requirements of AS 21.07.100 - 21.07.180. The report must include 27
242-(1) documentation of compliance with prior authorization response 28
243-times and other prior authorization requirements; 29
244-(2) evidence of transparency and accessibility of prior authorization
245-30
246-requirements and clinical review criteria; 31 34-LS0470\I
247-CSSB 133(L&C) -8- SB0133B
218+process to satisfy this requirement. The health care insurer or utilization review 1
219+organization shall disclose the process to the covered person and the covered person's 2
220+health care provider, along with the information needed to process the request, and 3
221+make the process available on the health care insurer's Internet website for the plan. 4
222+(c) A health care insurer or utilization review organization shall grant a step 5
223+therapy exception under this section if the covered person has tried the prescription 6
224+drugs required under the step therapy protocol while under a current or previous health 7
225+care insurance policy or health benefit plan, including a health care insurance policy or 8
226+health benefit plan offered by a different insurer or payor, and the prescription drugs 9
227+were discontinued because of lack of efficacy or effectiveness, diminished effect, or 10
228+an adverse event or if the covered person's health care provider attests that coverage of 11
229+the prescribed prescription drug is necessary to save the life of the covered person. 12
230+Use of drug samples from a pharmacy may not be considered trial and failure of a 13
231+preferred prescription drug required under a step therapy protocol. 14
232+(d) The health care insurer or utilization review organization may request 15
233+relevant information from the covered person or the covered person's health care 16
234+provider to support a step therapy exception request made under this section. Upon 17
235+granting a step therapy exception request, the health care insurer or utilization review 18
236+organization shall authorize dispensation of and coverage for the prescription drug 19
237+prescribed by the covered person's health care provider if the drug is a covered drug 20
238+under the health care insurance policy. 21
239+(e) This section may not be construed to prevent a 22
240+(1) health care insurer or utilization review organization from requiring 23
241+a covered person to try a generic equivalent or other brand name drug before 24
242+providing coverage for the requested prescription drug; or 25
243+(2) health care provider from prescribing a prescription drug that the 26
244+provider determines is medically appropriate. 27
245+Sec. 21.07.170. Annual report. A health care insurer shall submit an annual 28
246+report to the director, on a form prescribed by the director, detailing compliance with 29
247+the requirements of AS 21.07.100 - 21.07.180. The report must i
248+nclude 30
249+(1) documentation of compliance with prior authorization response 31 34-LS0470\N
250+SB 133 -8- SB0133A
248251 New Text Underlined [DELETED TEXT BRACKETED]
249252
250-(3) information on the implementation and functioning of any prior 1
251-authorization application programming interfaces; 2
252-(4) records of any prior authorization denials and the associated 3
253-appeals process, including the number of prior authorization approvals and denials, 4
254-reasons for denials, number of appeals, appeal outcomes, and, for the insurer's 20 most 5
255-frequently billed codes, average approval times by diagnosis code and demographic 6
256-information of the covered persons; 7
257-(5) any other information required by the director. 8
258-Sec. 21.07.180. Compliance and enforcement. (a) The director shall monitor 9
259-compliance with the provisions of AS 21.07.100 - 21.07.180. 10
260-(b) The director shall conduct examinations of health care insurers in 11
261-accordance with AS 21.06.120 - 21.06.230 to ensure compliance with AS 21.07.100 - 12
262-21.07.180. At least once every two years, the director shall conduct the examinations, 13
263-which may include reviewing 14
264-(1) prior authorization response times and adherence to specified time 15
265-frames; 16
266-(2) accuracy and completeness of prior authorization requirements and 17
267-restrictions published on the Internet website of the health care insurer; and 18
268-(3) consistency of prior authorization practices by all vendors, 19
269-utilization review organizations, and third-party contractors. 20
270-(c) If a health care insurer does not comply with AS 21.07.100 - 21.07.180, 21
271-the director may impose penalties, including a penalty for each instance of 22
272-noncompliance, an order to rectify deficiencies within a specified time frame, or, for 23
273-persistent or severe violations, suspension or revocation of the health care insurer's 24
274-certificate of authority. The director shall impose penalties based on the nature and 25
275-severity of the noncompliance, with consideration given to the health care insurer's 26
276-history of adherence to the requirements of AS 21.07.100 - 21.07.180 and efforts to 27
277-remedy violations. 28
278-(d) The director shall adopt regulations establishing penalties for 29
279-noncompliance with AS 21.07.100 - 21.07.180. The civil penalty for a single instance 30
280-of noncompliance may not exceed $25,000. 31 34-LS0470\I
281-SB0133B -9- CSSB 133(L&C)
253+times and other prior authorization requirements; 1
254+(2) evidence of transparency and accessibility of prior authorization 2
255+requirements and clinical review criteria; 3
256+(3) information on the implementation and functioning of any prior 4
257+authorization application programming interfaces; 5
258+(4) records of any prior authorization denials and the associated 6
259+appeals process, including the number of prior authorization approvals and denials, 7
260+reasons for denials, number of appeals, appeal outcomes, and, for the insurer's 20 most 8
261+frequently billed codes, average approval times by diagnosis code and demographic 9
262+information of the covered persons; 10
263+(5) any other information required by the director. 11
264+Sec. 21.07.180. Compliance and enforcement. (a) The director shall monitor 12
265+compliance with the provisions of AS 21.07.100 - 21.07.180. 13
266+(b) The director shall conduct examinations of health care insurers in 14
267+accordance with AS 21.06.120 - 21.06.230 to ensure compliance with AS 21.07.100 - 15
268+21.07.180. At least once every two years, the director shall conduct the examinations, 16
269+which may include reviewing 17
270+(1) prior authorization response times and adherence to specified time 18
271+frames; 19
272+(2) accuracy and completeness of prior authorization requirements and 20
273+restrictions published on the Internet website of the health care insurer; and 21
274+(3) consistency of prior authorization practices by all vendors, 22
275+utilization review organizations, and third-party contractors. 23
276+(c) If a health care insurer does not comply with AS 21.07.100 - 21.07.180, 24
277+the director may impose penalties, including a penalty for each instance of 25
278+noncompliance, an order to rectify deficiencies within a specified time frame, or, for 26
279+persistent or severe violations, suspension or revocation of the health care insurer's 27
280+certificate of authority. The director shall impose penalties based on the nature and 28
281+severity of the noncompliance, with consideration given to the health care insurer's 29
282+history of adherence to the requirements of AS 21.07.100 - 21.07.180 and efforts to 30
283+remedy violations. 31 34-LS0470\N
284+SB0133A -9- SB 133
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284- * Sec. 3. AS 21.07.250 is amended by adding new paragraphs to read: 1
285-(15) "chronic condition" means a medical condition or disease 2
286-expected to last at least 12 months or expected to persist over the lifetime of an 3
287-individual, requiring ongoing medical care to manage symptoms or prevent 4
288-progression; 5
289-(16) "covered person" means a policyholder, subscriber, enrollee, or 6
290-other individual participating in a health care insurance policy; 7
291-(17) "expedited request" means a request by a health care provider for 8
292-approval of medical care or a prescription drug when the covered person is undergoing 9
293-a current course of treatment using a nonformulary drug or for which the passage of 10
294-time 11
295-(A) could jeopardize the life or health of the covered person; 12
296-(B) could jeopardize the ability of a covered person to regain 13
297-maximum function; or 14
298-(C) would, as determined by a health care provider with 15
299-knowledge of the covered person's medical condition, subject the covered 16
300-person to severe pain that cannot be adequately managed without the medical 17
301-care or prescription drug that is the subject of the request; 18
302-(18) "prior authorization" means the process used by a health care 19
303-insurer to determine the medical necessity or medical appropriateness of covered 20
304-medical care before the medical care is provided; 21
305-(19) "standard request" means a request by a health care provider for 22
306-approval of medical care or a prescription drug for which the request is made in 23
307-advance of the covered person's obtaining medical care or a prescription drug that is 24
308-not required to be expedited; 25
309-(20) "step-therapy protocol" means a protocol, policy, or program used 26
310-by a health care insurer or utilization review organization that establishes which 27
311-prescription drugs are medically appropriate for a particular covered person and the 28
312-specific sequence in which the prescription drugs should be administered for a 29
313-specified medical condition, whether by self-administration or administration by a 30
314-health care provider, under a pharmacy or medical benefit of a health care insurance
315-31 34-LS0470\I
316-CSSB 133(L&C) -10- SB0133B
287+(d) The director shall adopt regulations establishing penalties for 1
288+noncompliance with AS 21.07.100 - 21.07.180. The civil penalty for a single instance 2
289+of noncompliance may not exceed $25,000. 3
290+ * Sec. 3. AS 21.07.250 is amended by adding new paragraphs to read: 4
291+(15) "chronic condition" means a medical condition or disease 5
292+expected to last at least 12 months or expected to persist over the lifetime of an 6
293+individual, requiring ongoing medical care to manage symptoms or prevent 7
294+progression; 8
295+(16) "covered person" means a policyholder, subscriber, enrollee, or 9
296+other individual participating in a health care insurance policy; 10
297+(17) "expedited request" means a request by a health care provider for 11
298+approval of medical care or a prescription drug when the covered person is undergoing 12
299+a current course of treatment using a nonformulary drug or for which the passage of 13
300+time 14
301+(A) could jeopardize the life or health of the covered person; 15
302+(B) could jeopardize the ability of a covered person to regain 16
303+maximum function; or 17
304+(C) would, as determined by a health care provider with 18
305+knowledge of the covered person's medical condition, subject the covered 19
306+person to severe pain that cannot be adequately managed without the medical 20
307+care or prescription drug that is the subject of the request; 21
308+(18) "prior authorization" means the process used by a health care 22
309+insurer to determine the medical necessity or medical appropriateness of covered 23
310+medical care before the medical care is provided or a requirement that a covered 24
311+person or health care provider notify a health care insurer before receiving or 25
312+providing medical care; 26
313+(19) "standard request" means a request by a health care provider for 27
314+approval of medical care or a prescription drug for which the request is made in 28
315+advance of the covered person's obtaining medical care or a prescription drug that is 29
316+not required to be expedited; 30
317+(20) "step-therapy protocol" means a protocol, policy, or program used 31 34-LS0470\N
318+SB 133 -10- SB0133A
317319 New Text Underlined [DELETED TEXT BRACKETED]
318320
319-plan; 1
320-(21) "utilization review organization" means an entity, other than a 2
321-health care insurer performing utilization review for the health care insurer's own 3
322-health insurance policy, that conducts any part of utilization review. 4
323- * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to 5
324-read: 6
325-TRANSITION: REGULATIONS. The director of the division of insurance may adopt 7
326-regulations necessary to implement this Act. The regulations take effect under AS 44.62 8
327-(Administrative Procedure Act), but not before the effective date of the law implemented by 9
328-the regulation. 10
329- * Sec. 5. Section 4 of this Act takes effect immediately under AS 01.10.070(c). 11
330- * Sec. 6. Except as provided in sec. 5 of this Act, this Act takes effect January 1, 2027. 12
321+by a health care insurer or utilization review organization that establishes which 1
322+prescription drugs are medically appropriate for a particular covered person and the 2
323+specific sequence in which the prescription drugs should be administered for a 3
324+specified medical condition, whether by self-administration or administration by a 4
325+health care provider, under a pharmacy or medical benefit of a health care insurance 5
326+plan; 6
327+(21) "utilization review organization" means an entity, other than a 7
328+health care insurer performing utilization review for the health care insurer's own 8
329+health insurance policy, that conducts any part of utilization review. 9
330+ * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to 10
331+read: 11
332+TRANSITION: REGULATIONS. The director of the division of insurance may adopt 12
333+regulations necessary to implement this Act. The regulations take effect under AS 44.62 13
334+(Administrative Procedure Act), but not before the effective date of the law implemented by 14
335+the regulation. 15
336+ * Sec. 5. Section 4 of this Act takes effect immediately under AS 01.10.070(c). 16
337+ * Sec. 6. Except as provided in sec. 5 of this Act, this Act takes effect January 1, 2027. 17