United StatesHealth plans would cover drugs for autoimmune and certain blood disorders
Group and individual health coverage would cover medicines indicated and prescribed for autoimmune diseases, hemophilia, or von Willebrand disease in plan years beginning on or after January 1, 2027.
What it does
Group and individual health coverage would cover medicines indicated and prescribed for autoimmune diseases, hemophilia, or von Willebrand disease. This would apply to plan years beginning on or after January 1, 2027.
Group and individual health coverage would generally limit advance approvals for autoimmune, hemophilia, and von Willebrand medicines to once per 12 months. Exceptions cover drugs typically used for 12 months or less, certain named medicines, and drugs requiring federal safety programs. The rule would apply to plan years beginning on or after January 1, 2027.
Argument forFor drugs covered by the approval limit, fewer repeat reviews could help patients continue treatment with fewer paperwork delays.
Argument againstLimiting repeat approvals could give insurers fewer chances to check whether long-term treatment still fits a patient's changing needs.
More detail
Group health plans and insurers offering group or individual coverage would cover these medicines. Medicines include drugs and biological products. The medicine must be indicated and prescribed to treat an autoimmune disease, hemophilia, or von Willebrand disease. Coverage would apply whether a pharmacy supplies it or it is given as part of another covered service. If enacted, this requirement would apply to plan years beginning on or after January 1, 2027.
Group health plans and insurers offering group or individual coverage generally could require advance approval only once during any 12-month period. The limit covers drugs and biological products indicated and prescribed for autoimmune diseases, hemophilia, or von Willebrand disease. Exceptions cover drugs typically used for 12 months or less. Exceptions also cover opioids, benzodiazepines, barbiturates, carisoprodol, and drugs requiring a special federal drug safety program. If enacted, this limit would apply to plan years beginning on or after January 1, 2027.
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Where it stands
- Introduced
- Passed House
- Passed Senate
- To President
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Jun 8Introduced in HouseLatest
- Jun 8Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and 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.Introduced
Healthcare