I
119THCONGRESS
1
STSESSION H. R. 639
To prohibit group health plans, health insurance issuers, and Federal health
care programs from applying prior authorization requirements, utilization
management techniques, and medical necessity reviews.
IN THE HOUSE OF REPRESENTATIVES
JANUARY22, 2025
Mr. V
ANDREWintroduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on
Oversight and Government Reform, for a period to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions
as fall within the jurisdiction of the committee concerned
A BILL
To prohibit group health plans, health insurance issuers,
and Federal health care programs from applying prior
authorization requirements, utilization management tech-
niques, and medical necessity reviews.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Doctor Knows Best 4
Act of 2025’’. 5
VerDate Sep 11 2014 02:55 Feb 19, 2025 Jkt 059200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H639.IH H639
kjohnson on DSK7ZCZBW3PROD with $$_JOB 2
•HR 639 IH
SEC. 2. PROHIBITING PRIOR AUTHORIZATION REQUIRE-1
MENTS, UTILIZATION MANAGEMENT TECH-2
NIQUES, AND MEDICAL NECESSITY REVIEWS. 3
(a) P
RIVATEINSURERS.—Subpart II of part A of 4
title XXVII of the Public Health Service Act (42 U.S.C. 5
300gg–11 et seq.) is amended by adding at the end the 6
following new section: 7
‘‘SEC. 2730. PROHIBITION ON PRIOR AUTHORIZATION RE-8
QUIREMENTS, UTILIZATION MANAGEMENT 9
TECHNIQUES, AND MEDICAL NECESSITY RE-10
VIEWS. 11
‘‘A group health plan, and a health insurance issuer 12
offering group or individual health insurance coverage, 13
may not impose any prior authorization requirement, any 14
utilization management technique (including any step 15
therapy or fail-first protocol), or any medical necessity re-16
view on any item or service for which benefits are available 17
under such plan or coverage.’’. 18
(b) F
EDERALHEALTHCAREPROGRAMS.—Begin-19
ning January 1, 2026, a Federal health care program (as 20
defined in section 1128B of the Social Security Act (42 21
U.S.C. 1320a–7b) and the health program established 22
under chapter 89 of title 5, United States Code, including 23
a State or any entity carrying out such Federal health 24
care program or health program, may not impose any 25
prior authorization requirement, any utilization manage-26
VerDate Sep 11 2014 02:55 Feb 19, 2025 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H639.IH H639
kjohnson on DSK7ZCZBW3PROD with $$_JOB 3
•HR 639 IH
ment technique (including any step therapy or fail-first 1
protocol), or any medical necessity review on any item or 2
service for which benefits are available under Federal 3
health care program or health program (as applicable). 4
(c) E
FFECTIVEDATE.—The amendment made by 5
subsection (a) shall apply with respect to plan years begin-6
ning on or after January 1, 2026. 7
Æ
VerDate Sep 11 2014 02:55 Feb 19, 2025 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6301 E:\BILLS\H639.IH H639
kjohnson on DSK7ZCZBW3PROD with $$_JOB