Prior Authorization Reform for Autoimmune and Blood Disorders Act

This bill would require employer group health plans and health insurers offering group or individual coverage to cover drugs prescribed to treat autoimmune diseases, hemophilia, or Von Willebrand disease. Coverage would apply whether the drug is dispensed by a pharmacy or given as part of another covered service. Plans could not require prior authorization for these drugs more than once in any 12-month period. Exceptions apply to drugs typically used for 12 months or less, to opioids, benzodiazepines, barbiturates, and carisoprodol, and to drugs that require a federal risk evaluation and mitigation strategy. The rules would apply to plan years beginning on or after January 1, 2027.

Full text and official record on Congress.gov

Sponsors

• Julie Johnson Democrat sponsor
• 2 cosponsors