Author: alaskaadmin

By: Yereth Rosen, Alaska Beacon

Health insurers must provide speedier responses to prior authorization requests for certain medical treatments and services, under a bill that went into law on Monday without Gov. Mike Dunleavy’s signature.

The measure, Senate Bill 133, requires insurers to notify patients within 72 hours whether the requested services are authorized in cases when requests are sent by fax or by other routine means. In cases of expedited requests, the insurer must provide answers within 24 hours, under the bill.

The bill, which passed unanimously in both the Senate and House, is intended to prevent delays in patient treatment, said the main sponsor, Sen. Jesse Bjorkman, R-Nikiski.

“Alaskans should not have to fight with their insurance company to get the care they need,” Bjorkman said in a statement. “This bill makes the process quicker, clearer, and fairer for everyone.”

The bill was officially sponsored by the Senate Labor and Commerce Committee, which Bjorkman chairs.

It was supported by medical organizations, including the Alaska Hospital and Healthcare Association, the Alaska State Medical Association and the Alaska Native Health Board.

It also got some qualified support from Premera Blue Cross Blue Shield of Alaska, the state’s largest health insurer.

In a March 25 letter to Bjorkman and members of the Senate Labor and Commerce Committee, Premera said that the version that emerged through the committee process had “some reasonable sideboards as well as incentives that will help plans modernize and improve their prior authorization systems so that these systems optimally serve providers, patients and plans alike.”

Premera said in its letter that it requires prior authorizations for care in only about 2% of cases, unlike insurers that “have been exceedingly aggressive in this space,” requiring prior authorization for up to 20% of all claims.

The bill has some exceptions, caveats and special provisions. For example, it does not prevent insurers from requiring generic versions of medicines prescribed by providers. It also has a section giving guidelines for insurers to grant exceptions for cancer patients who are covered by “step therapy” protocols. Those protocols provide patients with the least expensive medications first before advancing to more expensive medications.

Additionally, the bill gives insurers up to 14 working days to obtain more information from providers if they determine that there is a lack of sufficient information for decisions on prior authorization requests.

The new law goes into effect on Jan. 1, except for a portion that directs the state Division of Insurance to start drafting regulations. That portion went into effect immediately.