Reducing Medically Unnecessary Delays in Care Act of 2025
HB2433, the Reducing Medically Unnecessary Delays in Care Act of 2025, would change how prior authorization decisions are made under Medicare, Medicare Advantage, and Medicare prescription drug plans. The bill requires that coverage restrictions, denials, and other adverse determinations be based on medical necessity and written clinical criteria, and it directs plans and contractors to use evidence-based standards, update criteria at least annually, and post prior authorization rules and denial statistics publicly on their websites. It also requires advance notice before new or revised prior authorization requirements take effect.
A central feature of the bill is that prior authorization and adverse determinations must be made by a physician with an active, unrestricted license and appropriate specialty credentials, rather than by non-physician reviewers. The bill also requires plans to seek input from actively practicing physicians in the relevant service area before creating or materially changing clinical criteria. In effect, it would impose new federal contract requirements on Medicare administrative contractors, Medicare Advantage organizations, and Part D sponsors, and would likely increase oversight and transparency around utilization management in Medicare coverage decisions.
The bill would amend the terms of federal contracts with Medicare administrative contractors, Medicare Advantage plans, and prescription drug plan sponsors beginning 90 days after enactment. It would not directly rewrite the Medicare statute itself, but it would require HHS contracts to include detailed standards governing prior authorization, clinical criteria, physician involvement, notice, transparency, and reporting. The practical effect would be to constrain how these entities can deny or delay coverage for Medicare beneficiaries and to expand the role of physicians in utilization review decisions.
The available context suggests generally favorable sentiment toward the bill, reflected in its bipartisan introduction and the absence of recorded opposition in the provided materials. The bill was introduced by Representative Green of Tennessee with multiple cosponsors from both parties, and later Mr. Murphy assumed first sponsorship to add cosponsors and request reprinting, which indicates continued support and active promotion. No committee transcript or vote record is provided showing formal debate or dissent.
The main points of potential contention are likely to be operational and regulatory rather than ideological. Medicare contractors and plan sponsors may object to the cost, administrative burden, and reduced flexibility of requiring physician-only determinations, mandatory specialty matching, public posting of denial data, and advance notice for changes to prior authorization rules. Supporters, by contrast, appear to view these requirements as necessary to reduce medically unnecessary delays, improve transparency, and ensure that coverage decisions are made by clinicians with relevant expertise. The bill’s requirement that criteria be evidence-based and community-standard-based may also raise questions about how strictly plans can manage utilization when no independently developed evidence-based standard exists.