119-hr5467

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5467 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 5467

To amend title XVIII of the Social Security Act to require coverage of 
 drugs for autoimmune diseases and certain blood disorders under 
 Medicare part D.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 September 18, 2025

 Ms. Johnson of Texas (for herself and Mr. Kennedy of Utah) introduced 
 the following bill; which was referred to the Committee on Energy and 
 Commerce, and in addition to the Committee on 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 title XVIII of the Social Security Act to require coverage of 
 drugs for autoimmune diseases and certain blood disorders under 
 Medicare part D.

 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 ``Patient Access to Autoimmune 
Treatments Act'' or the ``PAAT Act''.

SEC. 2. REQUIRING COVERAGE OF DRUGS FOR AUTOIMMUNE DISEASES AND CERTAIN 
 BLOOD DISORDERS UNDER MEDICARE PART D.

 

Section 1860D-4 of the Social Security Act (42 U.S.C. 1395w-104) is 
amended--

    (1) in subsection

    (b)

    (3) , by adding at the end the 
 following new subparagraph:
 ``
        (J) Required inclusion of certain drugs for 
 autoimmune diseases and blood disorders.--
 ``
            (i) In general.--For 2027 and each 
 subsequent year, a PDP sponsor offering a 
 prescription drug plan shall include each 
 covered part D drug that is an autoimmune or 
 blood disorder drug described in clause
            (ii) .
 ``
            (ii) Autoimmune or blood disorder drug.--
 For purposes of clause
            (i) , a drug described in 
 this clause is a covered part D drug indicated 
 and prescribed for the treatment of an 
 autoimmune disease, hemophilia, or Von 
 Willebrand disease.''; and

    (2) in subsection
            (c) --
        (A) by redesignating paragraph

    (6) , as added by 
 

section 50354 of division E of the Bipartisan Budget 
 Act of 2018 (Public Law 115-123), as paragraph

    (7) ; and
        (B) by adding at the end the following new 
 paragraph:
 ``

    (8) Prohibition on use of prior authorization for certain 
 autoimmune or blood disorder drugs.--For plan years beginning 
 on or after January 1, 2027, a PDP sponsor offering a 
 prescription drug plan (and an MA organization offering an MA-
 PD plan) may not require, with respect to an individual 
 enrolled under such plan, that prior authorization for an 
 autoimmune or blood disorder drug (as described in subsection

    (b)

    (3)
        (J)
            (ii) ) 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.''.
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