Rep. Kennedy Introduces Bipartisan Bill to Tackle Overuse and Abuse of Prior Authorization

WASHINGTON, DC - Congressman Mike Kennedy (UT-03),along with Congresswoman Julie Johnson (TX-32), introduced the bipartisan Patient Access to Autoimmune Treatments Act , which limits prescription drug prior authorizations used by Medicare Advantage and stand-alone Part D plans to once per year for patients with autoimmune diseases or blood disorders.

Prior authorization requires physicians to get permission from a patient's insurance company before the patient can get certain treatments or medications. If the insurance company does not approve it, the patient's insurance will not pay for the medication or treatment. For patients with lifelong conditions like MS, rheumatoid arthritis, or type 1 diabetes, the process just creates unnecessary delays, stress, and paperwork.

"The Patient Access to Autoimmune Treatments Act takes a simple step to make Medicare Advantage work better for patients," said Congressman Mike Kennedy (UT-03). "By ensuring coverage of critical drugs and limiting prior authorization to once per year, we cut down on needless bureaucracy and give patients the certainty they deserve. This bipartisan reform is about streamlining the system so people can focus on their health, not paperwork."

"Patients battling chronic autoimmune diseases and blood disorders should not have to fight insurance companies just to access the treatments their doctors prescribe," said Johnson. "Requiring repeated prior authorizations for lifelong conditions does not make care safer-it makes it harder. It forces patients to wait for treatment, drives up costs, and puts their health at risk. Our bipartisan bill cuts through this red tape by ensuring only one prior authorization is required each year, so patients can focus on managing their health instead of filling out mounds of paperwork. This is about fairness, common sense, and making sure people get the care they need when they need it."

The bill has secured endorsements from the American Medical Association (AMA) , Autoimmune Association, American Society for Gastrointestinal Endoscopy, American College of Osteopathic Internists, American Academy of Physician Associates, and Texas Medical Association.

"Reforming prior authorization in Medicare Advantage is essential to protecting timely access to high-quality care and reducing the administrative burdens that contribute to physician burnout," said AMA President Bobby Mukkamala, M.D. "Alarmingly, the American Medical Association found that more than one in four physicians report prior authorization has led to a serious adverse event for a patient in their care. Patients living with chronic autoimmune and blood disorders are especially vulnerable to the delays and denials associated with frivolous prior authorization requirements. America's physicians applaud Reps. Julie Johnson and Mike Kennedy, M.D., for championing this bipartisan, common-sense legislation to put patients before paperwork."

"The Autoimmune Association, which advocates for more than 50 million Americans, is pleased to support the Patient Access to Autoimmune Treatments Act ," said Molly Murray, President and CEO, Autoimmune Association. "The prior authorization process is unpredictable and places an immense burden on both patients and providers. For patients, delays caused by prior authorization can lead to permanent disease progression. We appreciate Congresswoman Johnson's and Congressman Kennedy's unwavering leadership addressing this harmful insurance practice."

To read the full text of the bill, click here .