Doctor Knows Best Act of 2025

This bill would stop health insurers and federal health programs from making people get approval before care. It bans prior authorization, step therapy or “fail first” rules, and “medical necessity” reviews for any covered service. This applies to private group and individual plans and to federal programs, including the federal employee health program. The goal is that if your plan covers a service, your doctor’s order is enough—you shouldn’t have to wait for the insurer to say yes first. A summary from the Library of Congress confirms the same ban and timing.

Key points:

• Who is affected: People with private health insurance and people covered by federal health programs.
• What changes: No more prior authorization, step therapy/fail-first, or medical necessity reviews for covered items and services.
• When: Takes effect for plan years starting on or after January 1, 2026; the federal program ban begins January 1, 2026 .