119 HR 639 IH: Doctor Knows Best Act of 2025 U.S. House of Representatives 2025-01-22 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I119th CONGRESS1st SessionH. R. 639IN THE HOUSE OF REPRESENTATIVESJanuary 22, 2025Mr. Van Drew introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Oversight and Government Reform, 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 concernedA BILLTo prohibit group health plans, health insurance issuers, and Federal health care programs from applying prior authorization requirements, utilization management techniques, and medical necessity reviews.

1.

Short title

This Act may be cited as the Doctor Knows Best Act of 2025.

2.

Prohibiting prior authorization requirements, utilization management techniques, and medical necessity reviews

(a)

Private insurers

Subpart II of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–11 et seq.) is amended by adding at the end the following new section:

2730.

Prohibition on prior authorization requirements, utilization management techniques, and medical necessity reviews

A group health plan, and a health insurance issuer offering group or individual health insurance coverage, may not impose any prior authorization requirement, any utilization management technique (including any step therapy or fail-first protocol), or any medical necessity review on any item or service for which benefits are available under such plan or coverage.

.(b)

Federal health care programs

Beginning January 1, 2026, a Federal health care program (as defined in section 1128B of the Social Security Act (42 U.S.C. 1320a–7b) and the health program established under chapter 89 of title 5, United States Code, including a State or any entity carrying out such Federal health care program or health program, may not impose any prior authorization requirement, any utilization management technique (including any step therapy or fail-first protocol), or any medical necessity review on any item or service for which benefits are available under Federal health care program or health program (as applicable). (c)

Effective date

The amendment made by subsection (a) shall apply with respect to plan years beginning on or after January 1, 2026.