Prior Authorization Reform for Autoimmune and Blood Disorders Act
Sponsored By: Representative Johnson, Julie [D-TX-32]
Introduced
Summary
Creates uniform coverage and limits prior authorization for autoimmune and certain blood disorder drugs across employer plans, private insurers, and tax-advantaged health arrangements. It would require plans and insurers to cover any drug prescribed for autoimmune disease, hemophilia, or Von Willebrand disease regardless of whether the drug is dispensed at a pharmacy or furnished with another service. Prior authorization could not be required more than once in any 12-month period unless the drug is typically used for 12 months or less, is an opioid, benzodiazepine, barbiturate, or carisoprodol, or is subject to an FDA risk evaluation and mitigation strategy (REMS).
Show full summary
- Workers and employer-sponsored plans: Under the ERISA track, group health plans must cover these drugs regardless of dispensing location and generally may not require prior authorization more than once each 12 months except for the listed exceptions.
- People with private individual and group coverage: The Public Health Service Act track imposes the same coverage and prior-authorization rules on health insurance issuers offering group and individual policies.
- Tax-preferred plans and timing: The Internal Revenue Code track extends the rules to tax-advantaged group health plans and applies to plan years beginning on or after January 1, 2027.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Fewer prior authorizations for autoimmune patients
If enacted, the bill would require group health plans, health insurers that sell group or individual coverage, and employer tax-advantaged plans to cover drugs for autoimmune diseases, hemophilia, and Von Willebrand disease regardless of where the drug is dispensed. Plans and issuers would not be allowed to require prior authorization for the same enrolled person more than once in any 12-month period. The rule would not apply to drugs usually taken for 12 months or less, to opioids/benzodiazepines/barbiturates/carisoprodol, or to drugs that require a REMS safety program. These rules would start for plan years beginning on or after January 1, 2027.
Sponsors & CoSponsors
Sponsor
Johnson, Julie [D-TX-32]
TX • D
Cosponsors
Rep. Lawler, Michael [R-NY-17]
NY • R
Sponsored 6/8/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov