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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.
Summary
This bill prohibits group health plans, health insurance issuers, and Federal health care programs from requiring prior authorization, utilization management techniques (including step therapy or fail-first protocols), or medical necessity reviews for any covered items or services. The prohibition applies to private health insurance effective January 1, 2026, and to Federal health care programs including Medicare, Medicaid, and the Federal Employees Health Benefits Program also effective January 1, 2026. The bill prevents insurers and health programs from using these cost management and approval processes.
AI-generated plain-language summary of the bill text — neutral, and may be imperfect. See the full text below for the exact wording.
Sponsor (1)
Money behind the sponsor
Top reported contributors to Jefferson Van Drew’s campaign committee (2024 cycle) — who funds the bill’s sponsor, not a claim about this bill. Data from FEC.
- NULL $176,557
- ENTREPRENEUR $70,972
- PULSE VASCULAR $9,900
- ICONA RESORTS $9,900
- MONZO CATANESE HILLEGASS $9,000
Organizations whose employees gave the most — itemized individual contributions grouped by the donor’s reported employer (FEC Schedule A). Full finance for Jefferson Van Drew → · Outside spending →
Actions (2)
- Jan 22, 2025 Referred to the Committee on Energy and Commerce, and in addition to the Committee on Oversight and Government Reform, 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. · house
- Jan 22, 2025 Introduced in House
More bills on these subjects (8)
Other bills that carry the most legislative subjects in common with this one (topical discovery — distinct from the procedural related bills above).
Similar bills (6)
Bills with similar text or summary — includes reintroductions across Congresses. Ranked by semantic similarity of the bill text (computed locally); a neutral discovery aid, not a claim the bills are duplicates.
Text versions (1)
Bills are re-published as they move (Introduced → Reported → Engrossed → Enrolled …). Each stage below is a separate text; pick two to see what changed. Data from Congress.gov.
Full text
IN THE HOUSE OF REPRESENTATIVES
January 22, 2025
Mr. Van Drew introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Oversight and Government Reform, 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 prohibit group health plans, health insurance issuers, and Federal health care programs from applying prior authorization requirements, utilization management techniques, and medical necessity reviews.
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 “Doctor Knows Best Act of 2025”.
SEC. 2. PROHIBITING PRIOR AUTHORIZATION REQUIREMENTS, UTILIZATION MANAGEMENT TECHNIQUES, AND MEDICAL NECESSITY REVIEWS.
(a) Private Insurers.—Subpart II of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-11 et seq.) is amended by adding at the end the following new section:
“SEC. 2730. PROHIBITION ON PRIOR AUTHORIZATION REQUIREMENTS, UTILIZATION MANAGEMENT TECHNIQUES, AND MEDICAL NECESSITY REVIEWS.
“A group health plan, and a health insurance issuer offering group or individual health insurance coverage, may not impose any prior authorization requirement, any utilization management technique (including any step therapy or fail-first protocol), or any medical necessity review on any item or service for which benefits are available under such plan or coverage.”.
(b) Federal Health Care Programs.—Beginning January 1, 2026, a Federal health care program (as defined in section 1128B of the Social Security Act (42 U.S.C. 1320a-7b) and the health program established under chapter 89 of title 5, United States Code, including a State or any entity carrying out such Federal health care program or health program, may not impose any prior authorization requirement, any utilization management technique (including any step therapy or fail- first protocol), or any medical necessity review on any item or service for which benefits are available under Federal health care program or health program (as applicable).
(c) Effective Date.—The amendment made by subsection (a) shall apply with respect to plan years beginning on or after January 1, 2026. <all>
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