[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4349 Introduced in Senate (IS)]

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118th CONGRESS
  2d Session
                                S. 4349

   To require private health plans to provide for secure electronic 
  transmission of prior authorization requests for prescription drugs.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 15, 2024

Mr. Marshall (for himself, Mr. Lujan, Mr. Wicker, Mr. Manchin, and Mr. 
  Whitehouse) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
   To require private health plans to provide for secure electronic 
  transmission of prior authorization requests for prescription drugs.

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

SECTION 1. ELECTRONIC PRIOR AUTHORIZATION FOR PRESCRIPTION DRUGS.

    (a) PHSA.--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:

``SEC. 2799A-11. ELECTRONIC PRIOR AUTHORIZATION FOR PRESCRIPTION DRUGS.

    ``(a) In General.--For plan years beginning on or after January 1, 
2027, a group health plan or health insurance issuer offering group or 
individual health insurance coverage shall provide for the secure 
electronic transmission of--
            ``(1) a prior authorization request from the prescribing 
        health care professional for coverage of a prescription drug 
        for a participant, beneficiary, or enrollee in such plan or 
        coverage to such plan or issuer; and
            ``(2) a response, in accordance with this section, from 
        such plan or issuer to such professional.
    ``(b) Electronic Transmission.--
            ``(1) Exclusions.--For purposes of this section, a 
        facsimile, a proprietary payer portal that does not meet 
        standards specified by the Secretary, or an electronic form 
        shall not be treated as an electronic transmission described in 
        subsection (a).
            ``(2) Standards.--In order to be treated, for purposes of 
        this section, as an electronic transmission described in 
        subsection (a), such transmission shall comply with technical 
        standards adopted by the Secretary, in consultation with the 
        Secretary of Labor, the Secretary of the Treasury, the National 
        Council for Prescription Drug Programs, other standard-setting 
        organizations as determined appropriate by the Secretary, and 
        stakeholders, including group health plans and health insurance 
        issuers offering group or individual health insurance coverage, 
        health care professionals, and health information technology 
        software vendors.
            ``(3) Application.--Notwithstanding any other provision of 
        law, for purposes of this section, the Secretary may require 
        the use of standards adopted under paragraph (2) in lieu of any 
        other applicable standards for an electronic transmission 
        described in subsection (a) for prescription drugs for a 
        participant, beneficiary, or enrollee described in such 
        subsection.''.
    (b) ERISA.--
            (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:

``SEC. 726. ELECTRONIC PRIOR AUTHORIZATION FOR PRESCRIPTION DRUGS.

    ``(a) In General.--For plan years beginning on or after January 1, 
2027, a group health plan or health insurance issuer offering group 
health insurance coverage shall provide for the secure electronic 
transmission of--
            ``(1) a prior authorization request from the prescribing 
        health care professional for coverage of a prescription drug 
        for a participant or beneficiary in such plan or coverage to 
        such plan or issuer; and
            ``(2) a response, in accordance with this section, from 
        such plan or issuer to such professional.
    ``(b) Electronic Transmission.--
            ``(1) Exclusions.--For purposes of this section, a 
        facsimile, a proprietary payer portal that does not meet 
        standards specified by the Secretary, or an electronic form 
        shall not be treated as an electronic transmission described in 
        subsection (a).
            ``(2) Standards.--In order to be treated, for purposes of 
        this section, as an electronic transmission described in 
        subsection (a), such transmission shall comply with technical 
        standards adopted by the Secretary, in consultation with the 
        Secretary of Health and Human Services, the Secretary of the 
        Treasury, the National Council for Prescription Drug Programs, 
        other standard-setting organizations as determined appropriate 
        by the Secretary, and stakeholders, including group health 
        plans and health insurance issuers offering group health 
        insurance coverage, health care professionals, and health 
        information technology software vendors.
            ``(3) Application.--Notwithstanding any other provision of 
        law, for purposes of this section, the Secretary may require 
        the use of standards adopted under paragraph (2) in lieu of any 
        other applicable standards for an electronic transmission 
        described in subsection (a) for prescription drugs for a 
        participant or beneficiary described in such subsection.''.
            (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 725 the following:

``Sec. 726. Electronic prior authorization for prescription drugs.''.
    (c) IRC.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986 is amended by adding at the end 
        the following:

``SEC. 9826. ELECTRONIC PRIOR AUTHORIZATION FOR PRESCRIPTION DRUGS.

    ``(a) In General.--For plan years beginning on or after January 1, 
2027, a group health plan shall provide for the secure electronic 
transmission of--
            ``(1) a prior authorization request from the prescribing 
        health care professional for coverage of a prescription drug 
        for a participant or beneficiary in such plan to such plan; and
            ``(2) a response, in accordance with this section, from 
        such plan to such professional.
    ``(b) Electronic Transmission.--
            ``(1) Exclusions.--For purposes of this section, a 
        facsimile, a proprietary payer portal that does not meet 
        standards specified by the Secretary, or an electronic form 
        shall not be treated as an electronic transmission described in 
        subsection (a).
            ``(2) Standards.--In order to be treated, for purposes of 
        this section, as an electronic transmission described in 
        subsection (a), such transmission shall comply with technical 
        standards adopted by the Secretary of Health and Human 
        Services, in consultation with the Secretary of Labor, the 
        National Council for Prescription Drug Programs, other 
        standard-setting organizations as determined appropriate by the 
        Secretary, and stakeholders, including group health plans, 
        health care professionals, and health information technology 
        software vendors.
            ``(3) Application.--Notwithstanding any other provision of 
        law, for purposes of this section, the Secretary may require 
        the use of standards adopted under paragraph (2) in lieu of any 
        other applicable standards for an electronic transmission 
        described in subsection (a) for prescription drugs for a 
        participant or beneficiary described in such subsection.''.
            (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. 9826. Electronic prior authorization for prescription drugs.''.
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