HR 5467
PAAT Act
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Sign in to take action- Introduced
- Passed House
- Passed Senate
- To President
- Became Law
Bill overview
The Patient Access to Autoimmune Treatments Act (PAAT Act) aims to expand Medicare Part D coverage to include medications used to treat autoimmune diseases and certain blood disorders. Specifically, it requires prescription drug plans to cover these drugs starting in 2027. The bill also prohibits requiring prior authorization more than once for these medications, with limited exceptions.
Key provisions
- Requires prescription drug plans to cover drugs for autoimmune diseases and certain blood disorders.
- Mandates coverage beginning in 2027.
- Defines ‘autoimmune or blood disorder drug’ as indicated and prescribed for autoimmune diseases, hemophilia, or Von Willebrand disease.
- Prohibits more than one prior authorization requirement for these drugs within a 12-month period.
- Establishes exceptions to the prior authorization restriction for certain drugs (e.g., opioids, benzodiazepines, drugs with REMS requirements).
Who is affected
- Medicare beneficiaries
- Prescription drug plan sponsors (PDPs)
- Medicaid managed care organizations (MA-PD plans)
- Patients with autoimmune diseases and certain blood disorders
Notable changes
- Expands Medicare Part D coverage beyond standard formulary drugs.
- Introduces a restriction on prior authorization requirements for specific medications.
Sponsors
Official sponsors from legislative records.
Primary sponsor
Cosponsors
Eleanor Holmes [D-DC-At Large] Norton
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119th CONGRESS — 1st Session
H. R. 5467
IN THE HOUSE OF REPRESENTATIVES
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.
This Act may be cited as the Patient Access to Autoimmune Treatments Act PAAT Act
or the
.
Section 1860D–4 of the Social Security Act (42 U.S.C. 1395w–104) is amended—
in subsection (b)(3), by adding at the end the following new subparagraph:
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.
in subsection (c)—
by adding at the end the following new paragraph:
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—
an opioid, a benzodiazepine, a barbiturate, or carisoprodol; or