Preserving Patient Access Act

Bill Number

S. 4924

Origin Chamber

Senate

Congress

119th Congress, Session 2

Status

Introduced

Latest Action

2026-06-24: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

Last Updated

2026-07-07T04:53:29Z

AI-Generated Summary

Preserving Patient Access Act (S. 4924)

Purpose This legislation aims to maintain patient access to preferred health care providers and prescription drugs by creating new opportunities for individuals to switch health plans mid-year when networks or drug coverage change unexpectedly under Medicare Advantage, Medicare prescription drug plans, and individual market health insurance.

Key Provisions

• Medicare Advantage plans: Amends section 1851(e)(4) of the Social Security Act to add a special enrollment period if a provider who was in-network during the annual open enrollment becomes out-of-network. This applies if the individual had an in-person or telehealth visit with that provider in the prior 2 years.
• Medicare prescription drug plans and MA-PD plans: Adds a definition of "negative formulary change" (referencing existing regulations) for covered drugs that were previously covered and remain approved by the FDA. This applies to drugs dispensed in the prior 6 months.
• Individual market plans: Amends section 2702(b)(2) of the Public Health Service Act to require health insurance issuers to offer a special enrollment period during a plan year if a provider becomes out-of-network or if a negative formulary change occurs for a drug covered in the prior 6 months.
• Exchanges: Updates section 1311(c)(6)(C) of the Affordable Care Act to incorporate the new special enrollment rules.
• Effective date: Medicare changes apply to plan years beginning on or after January 1, 2027.

Significant Changes to Existing Law

• Introduces mid-year special enrollment periods in Medicare Advantage and individual market coverage, which did not previously exist for provider network shifts or formulary changes.
• Expands the definition and recognition of negative formulary changes (such as removing coverage, increasing costs, or adding restrictions) to trigger these periods.
• Modifies guaranteed issue and open enrollment rules under the Public Health Service Act and Affordable Care Act to include these new triggers.

Potential Impacts

• On citizens: Allows enrollees facing disruptions in provider access or drug coverage to switch plans without waiting for the next open enrollment, potentially improving continuity of care.
• On government agencies: Requires the Centers for Medicare & Medicaid Services (CMS) and health insurance exchanges to update enrollment systems, plan oversight, and guidance to implement the new periods.
• On plans and issuers: Health plans must monitor and accommodate these mid-year changes, which may affect network management and formulary design.
• No direct effects on international relations are addressed.

Main Stakeholders Affected

• Medicare beneficiaries and individual market enrollees.
• Medicare Advantage organizations, prescription drug plans, and MA-PD plans.
• Health insurance issuers offering individual coverage.
• Health care providers.
• State and federal health insurance exchanges.
• The Department of Health and Human Services.

Notable Legal, Constitutional, or Political Implications

• The bill amends core provisions of the Social Security Act and Public Health Service Act, directly affecting Medicare and Affordable Care Act-regulated markets.
• It relies on existing regulatory definitions (e.g., from 42 CFR 423.100) for key terms like negative formulary changes.
• No constitutional issues are raised in the text; implementation would occur through administrative rulemaking.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Sen. Rosen, Jacky [D-NV]

Cosponsors (1)

Sen. Curtis, John R. [R-UT]

Recent Actions

• 2026-06-24: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
• 2026-06-24: Introduced in Senate

Bill Versions

• Preserving Patient Access Act — issued 2026-06-24 — PDF (6 pages)