Bill > SB133

This bill introduces comprehensive reforms to prior authorization processes in health insurance, focusing on improving efficiency, transparency, and patient care. Starting January 1, 2027, health insurers will be required to establish a streamlined prior authorization process with specific time frames for making determinations, including responding within hours for standard and expedited requests. The bill mandates that insurers make their prior authorization standards publicly available online, base these standards on evidence-based clinical review criteria, and provide clear explanations for any adverse determinations. Insurers must also develop a digital application programming interface to automate prior authorization requests and create a more transparent process. The legislation includes special protections for patients with chronic conditions, ensuring prior authorizations for these conditions are valid for at least 12 months, and introduces step therapy restrictions, particularly for patients with Stage 4 advanced metastatic cancer, allowing exceptions when prescribed drugs are medically necessary. Additionally, the bill requires insurers to submit annual reports detailing their compliance with these new requirements and grants the state insurance director the authority to monitor and enforce these regulations, with potential penalties of up to $25,000 for non-compliance. These provisions aim to reduce administrative burdens on healthcare providers, improve patient access to necessary treatments, and increase transparency in the prior authorization process.

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https://www.akleg.gov/basis/Bill/Detail/34?Root=SB133