H.R. 9192: Prior Authorization Reform for Autoimmune and Blood Disorders Act

The bill, titled the **Prior Authorization Reform for Autoimmune and Blood Disorders Act**, is designed to improve health insurance coverage for certain medications related to autoimmune diseases and blood disorders. The key points of the legislation include:

1. Health Insurance Requirements

The bill requires that:

• Group health plans and health insurance issuers must provide coverage for any drug that is used to treat autoimmune diseases or specified blood disorders (such as hemophilia and Von Willebrand disease).
• Coverage applies regardless of whether the drug is dispensed at a pharmacy or provided as part of another healthcare service.

2. Prior Authorization Provisions

Health insurance plans are restricted in their prior authorization processes:

• They cannot require prior authorization for the specified drugs more than once per year, unless the drug:
• Is typically used for a duration of 12 months or less.
• Is categorized as an opioid, benzodiazepine, barbiturate, or carisoprodol.
• Requires special risk evaluation and mitigation strategies mandated by the FDA.

3. Definitions

The term **autoimmune or blood disorder drug** as defined in the bill encompasses any drug or biological product prescribed for treating autoimmune diseases, hemophilia, or Von Willebrand disease.

4. Amendments to Existing Laws

This bill proposes amendments to the following laws:

• The Employee Retirement Income Security Act of 1974 (ERISA)
• The Public Health Service Act
• The Internal Revenue Code of 1986

These amendments will ensure that the new coverage requirements are systematically integrated into current law.

5. Effective Date

The provisions of this bill will take effect for plan years starting on or after January 1, 2027.

Relevant Companies

• ABBV (AbbVie Inc.): A pharmaceutical company that produces various autoimmune disease treatments, which may see changes in market dynamics with the introduction of mandated coverage.
• AMGN (Amgen Inc.): A biopharmaceutical company known for its drugs treating autoimmune disorders; may also experience increased demand due to enhanced coverage.
• JNJ (Johnson & Johnson): This healthcare giant manufactures medications for blood disorders that may be included under the bill’s coverage mandates.