HR5467-119

1. Short title This Act may be cited as the Patient Access to Autoimmune Treatments Act or the PAAT Act.

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— in subsection (b)(3), by adding at the end the following new subparagraph: 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). 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. in subsection (c)— 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 by adding at the end the following new paragraph: 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— typically used for a period of 12 months or less; an opioid, a benzodiazepine, a barbiturate, or carisoprodol; or 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. (J)Required inclusion of certain drugs for autoimmune diseases and blood disorders (i)In generalFor 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 drugFor 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 (8)Prohibition on use of prior authorization for certain autoimmune or blood disorder drugsFor 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. .