Prior Authorization Relief Act

This bill changes prior authorization rules in the Medicare Advantage program. By January 1, 2027, the Secretary of Health and Human Services would audit prior authorization requirements to find items, services, and Part D drugs that are in the top 10 percent of reimbursements, have enough clinical evidence for a standard policy, and require too many steps to approve. By May 1, 2028, the Secretary would issue a final rule making prior authorization requirements for those items the same across all Medicare Advantage plans. Providers in certain two-sided risk models, such as some accountable care organizations, would be exempt from these requirements, but plans could ask the Secretary to keep their own prior authorization rules in place for those providers.

Full text and official record on Congress.gov

Sponsors

• Sheldon Whitehouse Democrat sponsor
• 1 cosponsors