Prior Authorization Relief Act

This bill requires the Medicare program to audit prior authorization requirements for high-cost medical services and drugs covered under Medicare Advantage plans by 2026. It identifies items/services where prior authorization is excessive (based on reimbursement rank, clinical evidence, and process complexity) and mandates standardized requirements across all Medicare Advantage plans by 2026. Certain Accountable Care Organizations (ACOs) meeting specific savings criteria will be exempt from these prior authorization rules for their Medicare Advantage patients in the following year. The bill directly affects Medicare Advantage plans, providers, and Medicare beneficiaries who use these services.