Alaska lawmakers passed a sweeping insurance reform bill last year that changes how insurers and pharmacy benefit managers operate in the state, effective Jan. 1.
Five notes:
- Pharmacy benefit managers and third-party administrators need licenses instead of just registering with the state. PBMs also have to work with the state’s Medicaid program and respond to claim inquiries within 60 days for any services provided within the last three years. They can’t deny claims because of when they were filed, what form was used, or if prior authorization wasn’t obtained upfront.
- If an insurer offers different coverage levels based on whether a provider is in-network, prior authorization request forms have to explain how patients and providers can ask for exceptions. When approving a prior authorization, insurers have to tell members whether the claim will be processed as in-network or out-of-network. If it’s going to be processed out-of-network but there’s a way to appeal that, the form needs to include those instructions.
- Insurers now have to give 45 days notice before canceling or not renewing a policy.
- HMOs have to cover emergency services at in-network cost-sharing levels even when members go to out-of-network providers. They also have to provide in-network cost sharing when one of their own providers refers a patient out of network for medically necessary care. HMOs can still deny the referral if there’s someone in-network who can provide the needed services.
- Some preventive care is now free. Insurers can’t charge copays, deductibles or any other cost sharing for mammograms, breast exams, breast biopsies or related consultations. The same goes for colorectal cancer screenings that follow American Cancer Society guidelines. The only exception is for high-deductible health plans that need to meet federal requirements for health savings accounts.
