PAAT Act

This bill would amend the Social Security Act so that, beginning in 2027, Prescription Drug Plan (PDP) sponsors must include on their formularies any Part D drug that is indicated and prescribed for an autoimmune disease, hemophilia, or Von Willebrand disease. It would also restrict prior authorization for those drugs so plans may not demand it more than once in any 12-month period, with explicit exceptions.

• Medicare beneficiaries with autoimmune conditions, hemophilia, or Von Willebrand disease would see their Part D plans required to list their prescribed drugs on formularies, improving the baseline availability of these treatments.
• Prescription Drug Plan sponsors and Medicare Advantage prescription drug (MA-PD) organizations would have to add these drugs and could not require prior authorization more than once every 12 months, except for drugs typically used 12 months or less, opioids, benzodiazepines, barbiturates, carisoprodol, or drugs subject to a FDA risk evaluation and mitigation strategy.
• Clinicians and pharmacies would face fewer repeated prior-authorization requests for these therapies because plans are limited in how often they can reauthorize treatment in a year.