Alaska Law Implements Time Limits for Prior Authorization Decisions on Medication Coverage

Prior authorizations (PAs) are pervasive in the delivery of US health care. They are a tool used by government and private health insurers to control costs and to ensure resources are being optimally utilized. Although developed for good fiscal management practices, PAs have also been prone to abuse and can lead to delays in necessary treatment. They have shifted an administrative burden onto medical practices and pharmacies to the degree that many physicians’ practices employ staff whose sole responsibility is to process PAs.¹

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In May 2025, the Alaska Legislature passed SB 133, which requires insurers to notify patients of PA decisions within 72 hours of the request submission. This law applies to PA requests for medical services and prescription drugs. Within this 72-hour range, the insurer can request additional information from the health care provider, which provides a limited extension of time for decision notification. The law includes a path for expedited requests, which must have a decision within 24 hours.²

The new legislation becomes effective January 1, 2026. The law is described as having support from patients, health care providers, pharmacies, and the largest health insurance provider in the state. In a statement, legislative sponsor Sen Jesse Bjorkman stated, “[T]his bill makes the process quicker, clearer, and fairer for everyone.”²

For several years, the American Medical Association has advocated for changes in medical service PAs, and a Centers for Medicare & Medicaid Services (CMS) final rule in 2024 implemented similar times for PA decisions.³ This policy is referred to as the Interoperability and Patient Access Final Rule. The CMS rule also required insurers to improve application programming interfaces (APIs). In simple terms, APIs are interfaces that increase communication between computer systems and enhance automation of decisions. The CMS interoperability rule streamlined administrative burden in medical practices, but the rule specifically excluded PA decisions regarding prescription medications.³ The American Pharmacists Association advocated for the CMS rule to cover medications.

Presently, there is a robust public discourse on drug pricing mechanisms and levels of transparency in decision-making processes. Although not under the same magnification as pharmacy benefit managers, PAs and API computer systems are poised to be an emerging strategy for advocacy for patients and improvements in pharmacy operations and finances.

REFERENCES

1. O’Reilly KB. Survey quantifies time burdens of prior authorization. American Medical Association. January 30, 2017. Accessed July 21, 2025. https://www.ama-assn.org/practice-management/prior-authorization/survey-quantifies-time-burdens-prior-authorization

2. Rosen Y. New Alaska law establishes quick deadlines for insurers’ decisions on medical care. Alaska Beacon. July 18, 2025. Accessed July 21, 2025. https://alaskabeacon.com/briefs/new-alaska-law-establishes-quick-deadlines-for-insurers-decisions-on-medical-care/

3. Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children’s Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS) Eligible Clinicians, and Eligible Hospitals and Critical Access Hospitals in the Medicare Promoting Interoperability Program. Fed Regist. 2024;89(27):8758-8988. 42 CFR §422, 431, 435, 438, 440, and 457 (2024); 45 CFR §156 (2024). Accessed July 21, 2025. https://www.federalregister.gov/documents/2024/02/08/2024-00895/medicare-and-medicaid-programs-patient-protection-and-affordable-care-act-advancing-interoperability

4. Re: [CMS-9123-P] Medicaid Program; Patient Protection and Affordable Care Act; Reducing Provider and Patient Burden by Improving Prior Authorization Processes, and Promoting Patients’ Electronic Access to Health Information for Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-facilitated Exchanges; Health Information Technology Standards and Implementation Specifications, Proposed Rule [Email]. January 4, 2021. Accessed July 21, 2025. https://aphanet.pharmacist.com/sites/default/files/audience/APhACommentstoCMSonMedicaidPriorAuthorization_Final.pdf