Applicability of prior authorization clinical criteria changes and utilization review provisions modification

This bill modifies rules for health insurance plans regarding changes to prior authorization requirements. It requires that if an insurance plan changes coverage terms or clinical criteria for a service, those changes cannot take effect until the next plan year for current enrollees who already received authorization under the old terms. Exceptions apply for safety-related changes, such as when the FDA deems a drug unsafe, or when independent research recommends changes due to patient harm risks. The key provision delays coverage changes to protect existing patients, with specific safety exceptions and a new effective date of January 1, 2026, for certain updates. This directly affects health insurance plans, enrollees, and healthcare providers who must follow these notice and transition rules.