HB5467, the Patient Access to Autoimmune Treatments Act (PAAT Act), would amend Medicare Part D to require prescription drug plans to include certain drugs used to treat autoimmune diseases and specific blood disorders. Beginning in 2027, Part D plan sponsors would have to cover covered drugs indicated and prescribed for autoimmune diseases, hemophilia, or Von Willebrand disease.
The bill also limits how often plans may require prior authorization for these drugs. For plan years starting on or after January 1, 2027, plans could not require prior authorization more than once in any 12-month period for these medications, unless the drug is typically used for 12 months or less, is an opioid, benzodiazepine, barbiturate, or carisoprodol, or is subject to a federal risk evaluation and mitigation strategy (REMS).
Impact
The bill would amend Section 1860D-4 of the Social Security Act, directly changing Medicare Part D coverage rules for prescription drug plans and Medicare Advantage prescription drug plans. It would create a federal coverage mandate for a defined set of autoimmune and blood disorder drugs and restrict repeated prior authorization requirements for those drugs, affecting Part D sponsors, MA organizations, Medicare beneficiaries with these conditions, and potentially plan formularies and utilization management practices.
Sentiment
The available context suggests generally supportive intent, with the bill introduced by bipartisan sponsors and framed around improving patient access to needed treatments. There is no recorded committee debate or vote history in the provided materials, so there is no evidence of organized opposition or formal controversy in the available record.
Contention
The main policy tension is between improving access to specialty medications for patients with chronic autoimmune and bleeding disorders and preserving plan flexibility to manage costs and utilization. The prior-authorization restriction may be the most notable point of contention for insurers and plan sponsors, while patient advocates and sponsors are likely to support the bill as a way to reduce administrative barriers and treatment delays. No specific objections or amendments are documented in the provided materials.
State plan for medical assistance services and health insurance; pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome.
An Act to amend and reenact §§ 38.2-3418.21 and 38.2-3418.22 of the Code of Virginia, relating to Bureau of Insurance; essential health benefits benchmark plan selection.
Allows remote patient monitoring of pregnant patients; requires reimbursement for remote patient monitoring rendered to certain Medicaid beneficiaries.
An Act to amend and reenact § 32.1-325 of the Code of Virginia, relating to Department of Medical Assistance Services; remote monitoring services through pregnancy and postpartum for high-risk pregnant patients and patients with advanced maternal age; reimbursement.