[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5467 Introduced in House (IH)]

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119th CONGRESS
  1st Session
                                H. R. 5467

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.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 18, 2025

 Ms. Johnson of Texas (for herself and Mr. Kennedy of Utah) introduced 
 the following bill; which was referred to the Committee on Energy and 
  Commerce, and in addition to the Committee on 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

_______________________________________________________________________

                                 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.

    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 ``Patient Access to Autoimmune 
Treatments Act'' or the ``PAAT Act''.

SEC. 2. REQUIRING COVERAGE OF DRUGS FOR AUTOIMMUNE DISEASES AND CERTAIN 
              BLOOD DISORDERS UNDER MEDICARE PART D.

    Section 1860D-4 of the Social Security Act (42 U.S.C. 1395w-104) is 
amended--
            (1) in subsection (b)(3), by adding at the end the 
        following new subparagraph:
                    ``(J) Required inclusion of certain drugs for 
                autoimmune diseases and blood disorders.--
                            ``(i) In general.--For 2027 and each 
                        subsequent year, a PDP sponsor offering a 
                        prescription drug plan shall include each 
                        covered part D drug that is an autoimmune or 
                        blood disorder drug described in clause (ii).
                            ``(ii) Autoimmune or blood disorder drug.--
                        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.''; and
            (2) in subsection (c)--
                    (A) by redesignating paragraph (6), as added by 
                section 50354 of division E of the Bipartisan Budget 
                Act of 2018 (Public Law 115-123), as paragraph (7); and
                    (B) by adding at the end the following new 
                paragraph:
            ``(8) Prohibition on use of prior authorization for certain 
        autoimmune or blood disorder drugs.--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--
                    ``(A) typically used for a period of 12 months or 
                less;
                    ``(B) an opioid, a benzodiazepine, a barbiturate, 
                or carisoprodol; or
                    ``(C) a drug with respect to which a risk 
                evaluation and mitigation strategy is required under 
                Section 505-1 of the Federal Food, Drug, and Cosmetic 
                Act.''.
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