Federal RuleAug 21
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DOL Rewrites Disability Rules for 'Merit-Based Opportunity' Push
RuleLabor DepartmentFederal Contract Compliance Programs OfficeSignificant Wallet
119-hr-639119th CongressWALLET
Doctor Knows Best Act of 2025
Sponsored By: Representative Van Drew, Jefferson [R-NJ-2]
Introduced
Summary
Ends prior authorization and other utilization controls for services a plan covers. This bill would bar group and individual health plans and federal health care programs from imposing prior authorization, step therapy, or medical necessity reviews for any item or service that the plan covers, effective for plan years beginning Jan. 1, 2026.
Show full summary
- Patients and families: Patients would face fewer prior-authorization delays and could get faster access to tests and treatments.
- Clinicians and providers: Clinicians would no longer need to obtain prior authorizations or navigate step-therapy protocols for covered services, reducing administrative work.
- Insurers and plan sponsors: Health insurers and plan sponsors would be prohibited from using utilization management tools to manage covered benefits, requiring them to change how they control access to care.
- Federal programs: Federal health care programs and the federal employees' health program are included under the ban starting Jan. 1, 2026.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
No prior authorization for covered care
This bill would ban prior authorization, step therapy, and medical-necessity reviews for covered care. It would apply to group health plans and insurers offering group or individual coverage, plus federal health care programs defined in law and the federal employee health program. For private coverage, it would start for plan years beginning on or after January 1, 2026; for federal programs and the federal employee program, it would start January 1, 2026. If passed, you and your doctor could face fewer paperwork delays to get covered services.
Sponsors & CoSponsors
Sponsor
Van Drew, Jefferson [R-NJ-2]
NJ • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov