H.R. 5467: Patient Access to Autoimmune Treatments Act

This bill, named the Patient Access to Autoimmune Treatments Act, aims to enhance access to medications for individuals with autoimmune diseases and certain blood disorders under Medicare Part D. Here are the key points of the legislation:

Coverage Requirements

• The bill requires that, starting in 2027, prescription drug plans (PDPs) that are part of Medicare must include all covered Part D drugs that are prescribed for the treatment of autoimmune diseases, hemophilia, and Von Willebrand disease.

Prior Authorization Regulations

• The legislation prohibits Medicare Part D plans from requiring prior authorization for certain autoimmune or blood disorder medications more than once in a 12-month period. This rule is set to take effect beginning January 1, 2027.
• Exceptions to the prior authorization restriction are included for:
  • Drugs typically prescribed for 12 months or less.
  • Opioids, benzodiazepines, barbiturates, or carisoprodol.
  • Drugs requiring a risk evaluation and mitigation strategy as mandated by the Federal Food, Drug, and Cosmetic Act.

Legislative Process

The bill was introduced in the U.S. House of Representatives by representatives Ms. Johnson of Texas and Mr. Kennedy of Utah. Once introduced, it was referred to the Committee on Energy and Commerce and the Committee on Ways and Means for further consideration.

Implications

This legislation is designed to improve access to critical treatments for individuals suffering from specified autoimmune diseases and blood disorders by mandating coverage under Medicare and streamlining the prior authorization process, which could help in reducing delays in receiving necessary medications.

Relevant Companies

• ABT (Abbott Laboratories): Abbott may see an impact due to its portfolio of autoimmune disease treatments.
• AMGN (Amgen Inc.): Amgen manufactures several drugs that treat autoimmune disorders, which could lead to increased utilization under Medicare.
• JNJ (Johnson & Johnson): Johnson & Johnson produces therapies for autoimmune conditions that would benefit from the expanded coverage.
• SNY (Sanofi): Sanofi offers medications for autoimmune diseases; increased access might boost their sales.