Preserving Patient Access Act
Sponsored By: Senator Rosen, Jacky [D-NV]
Introduced
Summary
Protects patients from mid‑year network and formulary changes. This bill adds rules so recent provider relationships and recent drug removals can trigger protections and enrollment options for Medicare and individual‑market enrollees.
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- Medicare Advantage enrollees: If you had an in‑person or telehealth visit with a provider in the prior two years and that provider was listed in‑network during the plan’s election period, the plan must treat that provider as out‑of‑network for the plan year.
- Medicare Part D and MA–PD enrollees: A plan’s “negative formulary change” that affects a drug dispensed to you within the prior six months can be treated as a mid‑year formulary change, using the definition in 42 C.F.R. 423.100.
- Individual market enrollees: If you were enrolled in another individual plan and that plan either (A) makes a listed provider you saw in the past two years out‑of‑network during the most recent open enrollment or (B) implements a negative formulary change affecting a drug dispensed or administered to you in the prior six months, you get a Special Enrollment Period to switch plans.
All changes apply to plan years beginning on or after January 1, 2027.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 2 benefits, 0 costs, 0 mixed.
Individual market mid-year switch
If enacted, you would be able to change individual market plans mid-year if your current plan (the initial plan) loses a provider you saw in the past 2 years or drops a drug you used in the past 6 months. The provider trigger applies when the provider was listed in-network during the most recent open enrollment period and then becomes out-of-network. The drug trigger applies when the initial plan makes a "negative formulary change" for a drug covered by the initial plan that was dispensed or administered to you in the previous 6 months and the drug still has FDA approval or PHSA licensure. These rules would apply to plan years beginning on or after January 1, 2027.
Medicare mid-year network protections
If enacted, Medicare Advantage enrollees would be treated as having a mid-year qualifying event if a provider you saw in the past 2 years who was listed as in-network during the plan's annual election period becomes out-of-network. If you are in Part D or an MA–PD plan, you would also be covered if the plan makes a "negative formulary change" for a covered Part D drug that was dispensed to you in the prior 6 months and the drug's FDA approval or PHSA licensure remains in effect. These changes would apply to plan years beginning on or after January 1, 2027.
Sponsors & CoSponsors
Sponsor
Rosen, Jacky [D-NV]
NV • D
Cosponsors
Sen. Curtis, John R. [R-UT]
UT • R
Sponsored 6/24/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov