Pharm'Up 
Alaska passed SB 133, a new law that places strict time limits on prior authorization (PA) decisions by insurers. Prior authorizations are a common tool used by insurance companies to manage costs and ensure a medical service or prescription drug is necessary before covering it. However, the process is often criticized for creating administrative burdens and delaying patient care. The new law, which takes effect on January 1, 2026, aims to make the process quicker, clearer, and fairer.
This legislation applies to both medical services and prescription drugs and has broad support from patients, healthcare providers, pharmacists, and the state’s largest health insurer.
Key Requirements of SB 133
- Standard Requests: Insurers must now notify patients of a prior authorization decision within 72 hours of receiving the request.
- Expedited Requests: For urgent requests, a decision must be made within just 24 hours.
- Information Requests: The law allows insurers to request additional information from a healthcare provider, but this only provides a limited extension to the 72-hour notification window.
Comparison to Federal Rules
The new Alaska law aligns with a 2024 final rule from the Centers for Medicare & Medicaid Services (CMS), which set similar timelines for PA decisions for medical services. However, a key difference is that the CMS rule specifically excludes prescription medications, an omission that the American Pharmacists Association had advocated against. The federal rule also focuses on improving Application Programming Interfaces (APIs) to automate the PA process, a strategy that is now poised to become more significant for pharmacy operations and finances.
About the Author
