PHARMACY BENEFITS MANAGER;3RD PARTY ADMIN
Sponsored By: Cathy Giessel (Republican)
Became Law
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Bill Overview
Analyzed Economic Effects
6 provisions identified: 3 benefits, 1 costs, 2 mixed.
Your right to choose your pharmacy
Beginning January 1, 2026, insurers and PBMs cannot block your choice of pharmacy or provider. They cannot block access to clinician‑administered drugs. Pharmacies may mail or deliver your medicines, and a signature is not required if the pharmacy keeps delivery records and replaces lost packages. PBMs cannot use your pharmacy claims data to steer you to their affiliates. Pharmacies may tell you if paying cash is cheaper than using your benefits.
Fair pay and billing rules for pharmacies
Beginning January 1, 2026, PBMs and insurers must pay independent pharmacies at least what they pay their own affiliates for the same drug, per unit. They cannot cut a pharmacy’s pay because a patient picked a different in‑network pharmacy, and they cannot use spread pricing. PBMs cannot charge pharmacies fees like claim processing, performance, participation, or accreditation fees. Pharmacies can charge patients for items not covered by insurance. PBMs and insurers cannot reverse and resubmit a pharmacy claim after 90 days unless they gave written notice, have just cause, tried to reconcile first, and explain the reason in writing.
Stronger TPA contracts and fast suspensions
Beginning January 1, 2026, insurers may only do business with licensed TPAs under a written contract that protects policyholder funds and gives the insurer audit and termination rights. Contracts must require monthly accounting and remittance, fiduciary handling of money, separate records, and a cap on TPAs holding more than three months of estimated claims funds and adjustment expenses. Contingency commissions are banned, except limited performance‑based pay for specific services. The director can immediately suspend a TPA license if it is insolvent, unsafe, or in delinquency proceedings, and TPAs are subject to hearings and penalties. The law also removes an older subsection to align rules.
State exams and costs for PBMs and TPAs
Beginning January 1, 2026, the Division of Insurance may examine PBMs and TPAs as often as needed, including with NAIC help. If examined, you must pay for examiner time based on salary, benefits, and division overhead, plus actual out‑of‑pocket costs and any contract examiner pay. The director can require electronic payment and may waive some or all costs if paying them would cause financial hardship for certain entities.
Licenses and renewals for PBMs and TPAs
Beginning January 1, 2026, anyone acting as a PBM or TPA in Alaska must be licensed. PBMs must apply with detailed owner, officer, and financial disclosures and must report key changes to the director within 30 days. PBM licenses renew every two years, and renewal fees fund enforcement staff, technology, and training. You may not operate on an expired license; reinstatement needs fees and a late penalty, and after two years expired, it cannot be renewed. The law spells out which sections apply to PBMs and TPAs, defines PBM, exempts certain compliance officers from a prelicensure rule, and requires TPAs to list any trade or assumed names on their license.
Who is exempt from TPA licensing
Beginning January 1, 2026, some groups do not need a TPA license. Insurers in good standing and their employees acting within job scope are exempt. Banks, credit unions, and mortgage lenders are exempt if they only advance premiums and collect insured debts, and credit card issuers are exempt if they only advance and collect authorized premiums. Firms that only serve ERISA‑preempted employee benefit plans are exempt, but must certify by February 1 each year. Other exempt persons must also file an annual certification by February 1. Most TPA employees do not need a personal TPA license, except the designated compliance officer. A TPA licensed under this chapter, or one that only adjusts claims and is licensed as an independent adjuster, does not need a managing general agent license.
Sponsors & Cosponsors
Sponsor
Cathy Giessel
Republican • Senate
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
(H) REFERRED TO RULES
5/17/2025House(H) L&C REFERRAL REMOVED
5/17/2025House(H) FN1: ZERO(CED)
5/16/2025House(H) NR: PRAX
5/16/2025House(H) DP: FIELDS, GRAY, RUFFRIDGE, MINA
5/16/2025House(H) HSS RPT HCS(HSS) 4DP 1NR
5/16/2025House(H) Minutes (HHSS)
5/15/2025House(H) Moved HCS SB 134(HSS) Out of Committee -- Delayed to 4:15 pm --
5/15/2025House(H) HEALTH & SOCIAL SERVICES at 03:15 PM DAVIS 106
5/15/2025HouseAudio/Video
5/15/2025House(H) HSS, L&C
5/14/2025House(H) READ THE FIRST TIME - REFERRALS
5/14/2025House(H) Minutes (HHSS)
5/13/2025House(H) <Pending Referral>
5/13/2025House(H) HEALTH & SOCIAL SERVICES at 03:15 PM DAVIS 106
5/13/2025House(S) VERSION: SB 134
5/13/2025Senate(S) TRANSMITTED TO (H)
5/13/2025Senate(S) EFFECTIVE DATE(S) SAME AS PASSAGE
5/13/2025Senate(S) PASSED Y20 N-
5/13/2025Senate(S) READ THE THIRD TIME SB 134
5/13/2025SenateAudio/Video
5/13/2025House(S) ADVANCED TO THIRD READING 5/13 CAL
5/12/2025Senate(S) READ THE SECOND TIME
5/12/2025Senate(S) RULES TO CALENDAR 5/12/2025
5/12/2025Senate(S) FN1: ZERO(CED)
5/7/2025Senate
Bill Text
HCS SB 134(HSS)
5/16/2025
SB 134
3/18/2025