AlaskaSB 13334th Legislature (2025-2026)Senate

INSURANCE; PRIOR AUTHORIZATIONS

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Bill Overview

Analyzed Economic Effects

7 provisions identified: 7 benefits, 0 costs, 0 mixed.

Fewer drug trial barriers for patients

Beginning January 1, 2027, Alaska insurers covering Stage 4 advanced metastatic cancer cannot require patients to try other drugs first for qualifying treatments. The drug must be FDA-approved and on the plan's covered drug list; its use must be FDA-approved or listed as Category 1 or 2A in the National Comprehensive Cancer Network Drugs and Biologics Compendium. Insurers and review organizations must also disclose a clear, convenient process for exceptions to drug trial rules. Exceptions are required when drugs tried under a current or previous plan were stopped because they failed, lost effect, or caused harm, or when a provider attests that the prescribed drug is needed to save the patient's life. Drug samples do not count toward required trials, and insurers can request supporting information; after granting an exception, insurers must authorize and cover the prescribed drug if the policy covers it.

Faster care approval decisions for patients

For Alaska plans issued or renewed on or after January 1, 2027, insurers must use a standard, efficient approval process. Complete requests require decisions within 72 hours for standard requests, including fax submissions, or 24 hours for urgent requests. Providers must certify that delay threatens life, health, recovery of maximum function, or causes severe pain that cannot be adequately managed. Insurers must confirm receipt and request missing information within three calendar days for standard requests or one for urgent requests. They can give providers 5–14 working days to respond, telling both patients and providers what is needed and the deadline. Requests count as approved when insurers miss the required deadline for written approval, denial, or a request for more information.

Longer care approvals for insured patients

Beginning January 1, 2027, Alaska insurers must keep chronic-care approvals valid for at least 12 months while patients remain covered. A chronic condition lasts at least 12 months or a lifetime and requires ongoing care. Approval automatically renews for another 12 months when treatment stays unchanged and the provider certifies compliance with the treatment plan. Other approvals must last at least 90 calendar days, or longer when clinically appropriate. Insurers must give providers and post online at least 60 days' notice before changing approval rules; both insurer and review-organization websites must reflect the change before it starts.

Clearer care rules and online approvals

Beginning January 1, 2027, Alaska insurers must post clear approval rules and required documents on their websites and portals. Rules must use peer-reviewed clinical evidence, apply consistently, and be reviewed and updated at least annually; conflicting insurer and review-organization rules must favor the patient. Listings must show whether standard electronic requests are available, when each requirement started, and when it first appeared online. Insurers must maintain a system that automates decisions and lets providers check requirements and exchange requests and decisions for care and drugs, including covered alternative drugs. The system must follow federal interoperability standards and implementation dates and flag specified denials or approvals for less-intensive care or different drugs as decisions patients can appeal.

Clearer denials and clinical patient reviews

Beginning January 1, 2027, Alaska insurers must let providers request clinical review of care approval requests. Reviewers must have relevant or equivalent specialty expertise and attest that they personally considered the submitted medical information. Providers can request the qualifications of a reviewer who issued an adverse decision. Insurers must notify both patients and providers of adverse decisions, giving specific evidence-based reasons, the criteria used, and missing or insufficient information. Notices must explain appeal rights, steps, deadlines, and contact information.

Coverage flexibility for religious nonmedical care

Beginning January 1, 2027, Alaska law preserves insurers' ability to cover care from religious nonmedical providers. Insurers are not required to use medical eligibility standards, require an examination, or use medical providers for access or appeal decisions. They are not required to exclude care because a religious provider withholds medical or other data that conflicts with that care. The law does not guarantee coverage.

Stronger oversight of insurer approval rules

Beginning January 1, 2027, Alaska's insurance director must monitor compliance and examine insurers at least once every two years. Insurers must report annually on response times, public rules, electronic systems, denials, and appeals. Reports must also show average approval times by diagnosis and patient demographics for the insurer's 20 most frequently billed procedure codes. The director can require fixes and impose penalties capped at $25,000 per violation, or suspend or revoke insurer authority for persistent or severe violations. The director's rulemaking authority starts immediately, but implementing rules cannot take effect before January 1, 2027.

Sponsors & Cosponsors

Sponsor

SENATE LABOR & COMMERCE
Affiliation unavailable

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 33 • No: 7

House vote • 5/18/2025

ADVANCED TO THIRD READING Y33 N7