119-hr639

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 639 Introduced in House

    (IH) ]

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119th CONGRESS
 1st Session
 H. R. 639

 To prohibit group health plans, health insurance issuers, and Federal 
 health care programs from applying prior authorization requirements, 
 utilization management techniques, and medical necessity reviews.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 January 22, 2025

 Mr. 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 concerned

_______________________________________________________________________

 A BILL

 To prohibit group health plans, health insurance issuers, and Federal 
 health care programs from applying prior authorization requirements, 
 utilization management techniques, and medical necessity reviews.

 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 ``Doctor Knows Best Act of 2025''.

SEC. 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:

``

SEC. 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.
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