As part of a multifaceted approach to reform prior authorization, Reps. Julie Johnson (D-TX) and Mike Lawler (R-NY) have introduced the Prior Authorization Reform for Autoimmune and Blood Disorders Act (H.R. 9192). This bipartisan legislation would limit the number of prior authorizations required by private health insurance plans, including self-insured plans governed by the Employee Retirement Income Security Act (ERISA), to once per year for drugs for patients with autoimmune diseases or blood disorders.
ASGE is among the endorsing organizations mentioned in a press release issued by Reps. Johnson and Lawler.
The provisions in this bill are very similar to those included in H.R. 5467, the Patient Access to Autoimmune Treatments (PAAT) Act, which was introduced by Reps. Johnson and Mike Kennedy, MD (R-UT) last fall and endorsed by ASGE. While H.R. 5467 also prevents repeat prior authorization reviews for drugs for autoimmune and blood disorders, the bill is restricted to Medicare Advantage prescription drug plans and stand-alone Medicare Part D plans. H.R. 9192 is centered on utilization management techniques for drugs treating these conditions in the private health insurance market, including self-insured ERISA plans.
H.R. 9192 is also endorsed by the American Medical Association and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.