Health plans would create clear ways for patients to get exceptions to 'step therapy' drug rules.
This bill would require group health plans and health insurance companies to set up a clear process for patients and their doctors to ask for exceptions to 'step therapy' drug rules. This means if a patient needs a specific medication, but their plan usually makes them try other drugs first, they could get a faster decision. This would allow them to use the requested drug and help prevent delays in getting the right treatment.
Today, group health plans and health insurance companies can use 'step therapy' rules without a federal requirement for a clear, fast, and open way for patients to ask for exceptions. This can lead to delays in getting the specific medication a doctor prescribes. After this bill, health plans would be required to set up a standardized exception process with specific reasons for approval and strict timelines, like 72 hours for standard requests and 24 hours for urgent ones, potentially speeding up access to needed drugs.
HR 5509 · 119th Congress · September 19, 2025 · AI Summary by gemini-2.5-flash · 8/10
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55 filings mentioned this bill
Amounts reflect total quarterly lobbying spend reported to the Senate, not bill-specific spending. Source: Senate LDA filings.