Prior Authorization Reform for Autoimmune and Blood Disorders Act
- Bill Number
- H.R. 9192
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-06-08: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-07-01T16:54:07Z
AI-Generated Summary
Summary of H.R. 9192: Prior Authorization Reform for Autoimmune and Blood Disorders Act
Purpose of the Legislation
This bill aims to mandate that certain health insurance plans cover specific medications used to treat autoimmune diseases and blood disorders. It also limits how often plans can require prior approval for these drugs, with the goal of improving access for affected individuals.
Key Provisions Outlined
- Coverage Requirements: Group health plans and issuers must cover any drug or biological product indicated for autoimmune diseases, hemophilia, or Von Willebrand disease. This applies whether the drug is obtained from a pharmacy or given as part of another covered service.
- Prior Authorization Limits: Plans may require prior authorization for these drugs no more than once in any 12-month period for an enrollee, unless the drug meets specific exceptions such as:
- Being typically used for 12 months or less.
- Being an opioid, benzodiazepine, barbiturate, or carisoprodol.
- Requiring a risk evaluation and mitigation strategy under federal drug law.
- Definition of Covered Drugs: An "autoimmune or blood disorder drug" refers to any medication or biological product prescribed for the listed conditions.
- Effective Date: The rules apply to plan years starting on or after January 1, 2027.
Significant Changes to Existing Law Introduced
- The bill adds new sections to three statutes: the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code of 1986.
- These amendments impose mandatory coverage and restrict prior authorization practices, which were not previously required under these laws for the specified drugs.
- It creates uniform standards across employer-sponsored plans, individual market coverage, and related tax provisions.
Potential Impacts
- On Government Agencies: Federal agencies like the Departments of Labor, Health and Human Services, and the Treasury may need to issue guidance or oversee compliance for affected plans.
- On Citizens: Individuals with autoimmune conditions or blood disorders could gain broader access to treatments, potentially reducing delays in care.
- On International Relations: No direct effects are outlined in the legislation.
- On Health Plans: Insurers and employers may face increased administrative or cost burdens due to expanded coverage obligations.
Main Stakeholders Affected
- Health insurance issuers and group health plans (including employer-sponsored plans).
- Patients diagnosed with autoimmune diseases, hemophilia, or Von Willebrand disease.
- Healthcare providers who prescribe or administer these medications.
- Pharmaceutical manufacturers producing the covered drugs.
Notable Legal, Constitutional, or Political Implications
- The legislation regulates health benefits in interstate commerce through amendments to existing federal statutes, potentially raising questions about the scope of congressional authority in health policy.
- It introduces exceptions for certain high-risk or controlled substances, which may interact with existing drug safety regulations.
- Introduced with bipartisan sponsorship, the bill focuses on reforming prior authorization processes without altering broader insurance mandates.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (1)
Rep. Lawler, Michael [R-NY-17]
Recent Actions
- 2026-06-08: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-06-08: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-06-08: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-06-08: Introduced in House
- 2026-06-08: Introduced in House
Bill Versions
- Prior Authorization Reform for Autoimmune and Blood Disorders Act — issued 2026-06-08 — PDF (6 pages)