State Requirements

Applicant must include business fax number, business email address and mailing address on the application.

All submitted phone numbers must be exactly 10 digits.

Applicant must be licensed in applicant's home state.

Any changes to the lines of the authority (LOAs) on the license being renewed must be made directly with the Alaska Division of Insurance.

Applicants must renew all classes/LOAs appearing as active on Producer Database (PDB) associated with applicant license class.

Applicant is required to enter exactly one (1) Designated Responsible Licensed Producer (DRLP) on the application and have an active resident or non-resident license in Alaska. Applicant may not enter more than one DRLP.

The DRLP listed must cumulatively cover the LOAs requested on the application. To be valid LOAs, DRLP LOAs must be active and be associated with the same license class as the applicant license class.

If applicant responds "yes" to one of the background questions please submit supporting documents electronically via NIPR's Attachments Warehouse. The documents may also be submitted to the state via mail, email, or fax.

Applications not completed within four (4) months from the date filed will be considered withdrawn and new application forms and fees will be required pursuant to Alaska Statute 21.27.040(f).

Pharmacy Benefit Manager Applicants

All Pharmacy Benefit Applicants are required to submit the following documentation to the NIPR attachment warehouse:

1. All basic organizational documents of the Pharmacy Benefit Manager, including articles of incorporation, articles of association, articles of organization, partnership agreement, trade name certificate, trust agreement, shareholder agreement and other applicable documents and all endorsements to the required documents.
2. Bylaws, operating agreement, rules, regulations and similar documents regulating the internal affairs of the benefit manager.
3. The names, mailing addresses, physical addresses, official positions and professional qualifications of persons who are responsible for the conduct of affairs of the Pharmacy Benefit Manager, including the members of the board of directors, members of the limited liability company or partnership, board of trustees, executive committee or other governing board or committee, the principal officers in the case of a corporation or the partners or members in the case of a partnership or association, shareholders holding directly or indirectly 10 percent or more of the voting securities of the Pharmacy Benefit Manager and any other person who exercises control or influence over the affairs of the Pharmacy Benefit Manager.
4. Certified (audited) financial statements for the prior two years prepared by an independent certified public accountant that establish that the applicant is solvent, that the applicant's system of accounting, internal control and procedure is operating effectively to provide reasonable assurance that money is promptly accounted for and paid to the person entitled to the money. (If the applicant submits a consolidated statement, a consolidating worksheet for the applicant must also be included.)
5. A statement describing the business plan including information on staffing levels and activities proposed in this state and in other jurisdictions and provide details establishing the Pharmacy Benefit Manager’s capability for providing a sufficient number of experienced and qualified personnel in the areas of claims handling, underwriting, and record keeping.
6. Identify the key personnel who supervise or have responsibility over personnel performing Pharmacy Benefit Manager functions.