Prior Authorization Reform for Autoimmune and Blood Disorders Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9192 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 9192

  To amend the Employee Retirement Income Security Act of 1974, title
 XXVII of the Public Health Service Act, and the Internal Revenue Code
of 1986 to require health insurance coverage of drugs indicated for the
     treatment of autoimmune diseases and certain blood disorders.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                              June 8, 2026

   Ms. Johnson of Texas (for herself and Mr. Lawler) introduced the
   following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committees on Education and Workforce,
 and Ways and Means, for a period to be subsequently determined by the
  Speaker, in each case for consideration of such provisions as fall
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

  To amend the Employee Retirement Income Security Act of 1974, title
 XXVII of the Public Health Service Act, and the Internal Revenue Code
of 1986 to require health insurance coverage of drugs indicated for the
     treatment of autoimmune diseases and certain blood disorders.

    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Prior Authorization Reform for
Autoimmune and Blood Disorders Act''.

SEC. 2. REQUIRING COVERAGE OF DRUGS INDICATED FOR THE TREATMENT OF
              AUTOIMMUNE DISEASES AND CERTAIN BLOOD DISORDERS.

    (a) ERISA Amendments.--
            (1) In general.--Subpart B of part 7 of subtitle B of title
        I of the Employee Retirement Income Security Act of 1974 (29
        U.S.C. 1185 et seq.) is amended by adding at the end the
        following new section:

``SEC. 727. REQUIREMENTS WITH RESPECT TO COVERAGE OF DRUGS FOR
              AUTOIMMUNE DISEASES AND CERTAIN BLOOD DISORDERS.

    ``(a) In General.--A group health plan, and a health insurance
issuer offering group health insurance coverage--
            ``(1) shall provide coverage for any drug that is an
        autoimmune or blood disorder drug, without regard to whether
        such drug is dispensed by a pharmacy or furnished incident to
        another item or service for which benefits are available under
        such plan or coverage; and
            ``(2) may not require, with respect to an individual
        enrolled under such plan or coverage, that prior authorization
        for such a drug be obtained more than once during any 12-month
        period unless such drug is--
                    ``(A) typically used for a period of 12 months or
                less;
                    ``(B) an opioid, a benzodiazepine, a barbiturate,
                or carisoprodol; or
                    ``(C) a drug with respect to which a risk
                evaluation and mitigation strategy is required under
                Section 505-1 of the Federal Food, Drug, and Cosmetic
                Act.
    ``(b) Autoimmune or Blood Disorder Drug Defined.--In this section,
the term `autoimmune or blood disorder drug' means a drug or biological
product that is indicated and prescribed for the treatment of an
autoimmune disease, hemophilia, or Von Willebrand disease.''.
            (2) Clerical amendment.--The table of contents in section 1
        of the Employee Retirement Income Security Act of 1974 (29
        U.S.C. 1001 et seq.) is amended by inserting after the item
        relating to section 726 the following:

``Sec. 727. Requirements with respect to coverage of drugs for
                            autoimmune diseases and certain blood
                            disorders.''.
    (b) Public Health Service Act Amendments.--Part D of title XXVII of
the Public Health Service Act (42 U.S.C. 300gg-111 et seq.) is amended
by adding at the end the following new section:

``SEC. 2799A-12. REQUIREMENTS WITH RESPECT TO COVERAGE OF DRUGS FOR
              AUTOIMMUNE DISEASES AND CERTAIN BLOOD DISORDERS.

    ``(a) In General.--A group health plan, and a health insurance
issuer offering group or individual health insurance coverage--
            ``(1) shall provide coverage for any drug that is an
        autoimmune or blood disorder drug, without regard to whether
        such drug is dispensed by a pharmacy or furnished incident to
        another item or service for which benefits are available under
        such plan or coverage; and
            ``(2) may not require, with respect to an individual
        enrolled under such plan or coverage, that prior authorization
        for such a drug be obtained more than once during any 12-month
        period unless such drug is--
                    ``(A) typically used for a period of 12 months or
                less;
                    ``(B) an opioid, a benzodiazepine, a barbiturate,
                or carisoprodol; or
                    ``(C) a drug with respect to which a risk
                evaluation and mitigation strategy is required under
                Section 505-1 of the Federal Food, Drug, and Cosmetic
                Act.
    ``(b) Autoimmune or Blood Disorder Drug Defined.--In this section,
the term `autoimmune or blood disorder drug' means a drug or biological
product that is indicated and prescribed for the treatment of an
autoimmune disease, hemophilia, or Von Willebrand disease.''.
    (c) Internal Revenue Code Amendments.--
            (1) In general.--Subchapter B of chapter 100 of the
        Internal Revenue Code of 1986 is amended by adding at the end
        the following new section:

``SEC. 9827. REQUIREMENTS WITH RESPECT TO COVERAGE OF DRUGS FOR
              AUTOIMMUNE DISEASES AND CERTAIN BLOOD DISORDERS.

    ``(a) In General.--A group health plan--
            ``(1) shall provide coverage for any drug that is an
        autoimmune or blood disorder drug, without regard to whether
        such drug is dispensed by a pharmacy or furnished incident to
        another item or service for which benefits are available under
        such plan; and
            ``(2) may not require, with respect to an individual
        enrolled under such plan, that prior authorization for such a
        drug be obtained more than once during any 12-month period
        unless such drug is--
                    ``(A) typically used for a period of 12 months or
                less;
                    ``(B) an opioid, a benzodiazepine, a barbiturate,
                or carisoprodol; or
                    ``(C) a drug with respect to which a risk
                evaluation and mitigation strategy is required under
                Section 505-1 of the Federal Food, Drug, and Cosmetic
                Act.
    ``(b) Autoimmune or Blood Disorder Drug Defined.--In this section,
the term `autoimmune or blood disorder drug' means a drug or biological
product that is indicated and prescribed for the treatment of an
autoimmune disease, hemophilia, or Von Willebrand disease.''.
            (2) Clerical amendment.--The table of sections for
        subchapter B of chapter 100 of the Internal Revenue Code of
        1986 is amended by adding at the end the following new item:

``Sec. 9827. Requirements with respect to coverage of drugs for
                            autoimmune diseases and certain blood
                            disorders.''.
    (d) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2027.
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