Prior Authorization Reform for Autoimmune and Blood Disorders Act

The Prior Authorization Reform for Autoimmune and Blood Disorders Act requires group health plans and health insurers to cover specific medications for autoimmune diseases, hemophilia, and Von Willebrand disease without restricting how they are administered. To improve access, the bill limits prior authorization requirements for these drugs to no more than once every 12 months, unless the medication is short-term, classified as an opioid or benzodiazepine, or carries a specific government-mandated risk management strategy. These rules apply to plans governed by federal laws including ERISA, the Public Health Service Act, and the Internal Revenue Code, with coverage beginning for plan years starting on or after January 1, 2027.