Sponsors (2)
The bill strengthens access and continuity of critical drug therapies for people with certain chronic conditions by limiting prior authorization and mandating coverage across plan types, but it raises costs and administrative burdens that could lead to higher premiums or continued burdens for some drugs.
People with autoimmune diseases, hemophilia, or Von Willebrand disease will have guaranteed coverage for medically indicated drugs regardless of how the drug is dispensed, reducing risk of treatment gaps for these patients.
Limits prior-authorization to once per 12-month period for ongoing therapies, cutting administrative delays and reducing interruptions in care for many chronic drug users.
Creates consistent coverage rules by applying the requirement across ERISA, the PHSA, and the tax code, reducing legal and coverage variability between employer, individual, and other plans.
Health plans and insurers may face higher drug spending, which could be passed to consumers through higher premiums or increased cost‑sharing.
The 12‑month prior‑authorization cap still permits more frequent reviews for short‑term, controlled, or REMS drugs, meaning some patients could continue to face disruptions in treatment.
Insurers and plans will likely incur increased administrative and compliance costs to implement and maintain the new statutory requirements across ERISA, PHSA, and the tax code.
Based on analysis of 2 sections of legislative text.
Requires coverage of drugs for autoimmune and specified blood disorders and limits prior-authorization renewals to once every 12 months, with exceptions.
Requires group health plans and health insurance issuers to cover drugs prescribed for autoimmune diseases, hemophilia, or Von Willebrand disease and limits prior-authorization for those drugs to once per 12-month period, with limited exceptions. The rule is added across ERISA, the Public Health Service Act, and the Internal Revenue Code and takes effect for plan years beginning on or after January 1, 2027.
Official title: To amend the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to require health insurance coverage of drugs indicated for the treatment of autoimmune diseases and certain blood disorders.
Introduced June 8, 2026 by Julie Johnson · Last progress June 8, 2026