Reducing Medically Unnecessary Delays in Care Act of 2025

Clearer Medicare prior authorization rules

If enacted, Medicare contractors, Medicare Advantage plans, and Medicare drug plans would have new prior authorization rules for contracts that apply starting 90 days after enactment. Plans would have to give doctors at least 60 days’ written notice before new prior authorization rules begin and post easy-to-read rules and clinical criteria on their websites. They would also post approval and denial rates by doctor specialty, drug or test, diagnosis, and reason. Prior authorization and denial decisions would be made by a licensed, board-certified (or eligible) doctor in the same specialty, using evidence-based criteria reviewed each year with input from practicing doctors. If no independent evidence standard exists for a service, a plan could not deny it just for that reason.