Alaska Statutes Title 21. Insurance § 21.07.160. Step therapy restrictions and exceptions

(a) A health care insurer that provides coverage under a health care insurance policy for the treatment of Stage 4 advanced metastatic cancer may not limit or exclude coverage under the health benefit plan for a drug that is approved by the United States Food and Drug Administration and that is on the insurer's prescription drug formulary by mandating that a covered person with Stage 4 advanced metastatic cancer undergo step therapy if the use of the approved drug is an approved indication by the United States Food and Drug Administration or on the National Comprehensive Cancer Network Drugs and Biologics Compendium as an indication for the treatment of Stage 4 advanced metastatic cancer consistent with Category 1 or Category 2A of evidence and consensus or peer-reviewed medical literature.

(b) If coverage of a prescription drug for the treatment of any medical condition is restricted by a health care insurer or utilization review organization because of a step therapy protocol, the health care insurer or utilization review organization must provide a covered person and the covered person's health care provider with access to a clear, convenient, and readily accessible process for requesting an exception to application of the step therapy protocol.  A health care insurer or utilization review organization may use its existing medical exceptions process to satisfy this requirement.  The health care insurer or utilization review organization shall disclose the process to the covered person and the covered person's health care provider, along with the information needed to process the request, and make the process available on the health care insurer's Internet website for the plan.

(c) A health care insurer or utilization review organization shall grant a step therapy exception under this section if the covered person has tried the prescription drugs required under the step therapy protocol while under a current or previous health care insurance policy or health benefit plan, including a health care insurance policy or health benefit plan offered by a different insurer or payor, and the prescription drugs were discontinued because of lack of efficacy or effectiveness, diminished effect, or an adverse event or if the covered person's health care provider attests that coverage of the prescribed prescription drug is necessary to save the life of the covered person.  Use of drug samples from a pharmacy may not be considered trial and failure of a preferred prescription drug required under a step therapy protocol.

(d) The health care insurer or utilization review organization may request relevant information from the covered person or the covered person's health care provider to support a step therapy exception request made under this section.  Upon granting a step therapy exception request, the health care insurer or utilization review organization shall authorize dispensation of and coverage for the prescription drug prescribed by the covered person's health care provider if the drug is a covered drug under the health care insurance policy.

(e) This section may not be construed to prevent a