Legis Daily

Ensuring Patient Access to Critical Breakthrough Products Act

USA119th CongressHR-5343| House 
| Updated: 9/17/2025
Blake D. Moore

Blake D. Moore

Republican Representative

Utah

Cosponsors (37)
Celeste Maloy (Republican)Chris Pappas (Democratic)Chrissy Houlahan (Democratic)Darren Soto (Democratic)Mike Carey (Republican)Claudia Tenney (Republican)Terri A. Sewell (Democratic)Aaron Bean (Republican)Jimmy Panetta (Democratic)J. Luis Correa (Democratic)Steve Cohen (Democratic)Suzan K. DelBene (Democratic)Angie Craig (Democratic)Earl L. "Buddy" Carter (Republican)Jake Auchincloss (Democratic)Ted Lieu (Democratic)Rudy Yakym (Republican)Gus M. Bilirakis (Republican)Daniel Meuser (Republican)Carol D. Miller (Republican)Marilyn Strickland (Democratic)John Joyce (Republican)Cliff Bentz (Republican)Brittany Pettersen (Democratic)Ami Bera (Democratic)Brian K. Fitzpatrick (Republican)Deborah K. Ross (Democratic)Lori Trahan (Democratic)Burgess Owens (Republican)Randy K. Sr. Weber (Republican)Josh Gottheimer (Democratic)Zoe Lofgren (Democratic)Michael Lawler (Republican)Bradley Scott Schneider (Democratic)Michelle Fischbach (Republican)Jennifer A. Kiggans (Republican)Nicole Malliotakis (Republican)

Ways and Means Committee, Energy and Commerce Committee

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
This bill, titled the "Ensuring Patient Access to Critical Breakthrough Products Act," aims to streamline Medicare coverage for innovative medical technologies. It establishes a new 4-year transitional coverage period for devices designated as "breakthrough" by the Secretary of Health and Human Services, ensuring beneficiaries can access these products more quickly. During this period, Medicare will cover these devices unless they are used outside their Food and Drug Administration (FDA)-approved labeling or are found to pose an undue risk of harm. To qualify for this transitional coverage, a device must meet specific criteria, including having received priority review from the FDA. The Secretary must also determine that the device would otherwise be covered under Medicare Parts A or B and does not present an undue risk of harm that outweighs its potential clinical benefits. The bill mandates a clear process for manufacturers to apply for this designation, requiring a determination within six months and an explanation if the designation is denied. Furthermore, the legislation requires the Secretary to make a final National Coverage Determination (NCD) for a breakthrough device before the end of its 4-year transitional coverage period. This ensures a permanent coverage decision is in place following the temporary period, provided the NCD request was submitted sufficiently in advance. The bill also appropriates $10 million annually from fiscal years 2025 through 2030 to the Centers for Medicare & Medicaid Services to implement these new provisions.
View Full Text

Suggested Questions

Get AI-generated questions to help you understand this bill better

Timeline

Bill from Previous Congress

HR 116-5333
Ensuring Patient Access to Critical Breakthrough Products Act of 2019

Bill from Previous Congress

HR 117-4043
Ensuring Patient Access to Critical Breakthrough Products Act of 2021

Bill from Previous Congress

HR 118-1691
Ensuring Patient Access to Critical Breakthrough Products Act of 2024
May 12, 2025

Latest Companion Bill Action

S 119-1717
Introduced in Senate
Sep 15, 2025
Introduced in House
Sep 15, 2025
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sep 17, 2025
Committee Consideration and Mark-up Session Held
Sep 17, 2025
Ordered to be Reported in the Nature of a Substitute (Amended) by the Yeas and Nays: 37 - 3.
  • Bill from Previous Congress

    HR 116-5333
    Ensuring Patient Access to Critical Breakthrough Products Act of 2019


  • Bill from Previous Congress

    HR 117-4043
    Ensuring Patient Access to Critical Breakthrough Products Act of 2021


  • Bill from Previous Congress

    HR 118-1691
    Ensuring Patient Access to Critical Breakthrough Products Act of 2024


  • May 12, 2025

    Latest Companion Bill Action

    S 119-1717
    Introduced in Senate


  • September 15, 2025
    Introduced in House


  • September 15, 2025
    Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.


  • September 17, 2025
    Committee Consideration and Mark-up Session Held


  • September 17, 2025
    Ordered to be Reported in the Nature of a Substitute (Amended) by the Yeas and Nays: 37 - 3.

Health

Congressional oversightDrug safety, medical device, and laboratory regulationHealth care costs and insuranceHealth care coverage and accessHealth programs administration and fundingHealth technology, devices, suppliesMedicare

Ensuring Patient Access to Critical Breakthrough Products Act

USA119th CongressHR-5343| House 
| Updated: 9/17/2025
This bill, titled the "Ensuring Patient Access to Critical Breakthrough Products Act," aims to streamline Medicare coverage for innovative medical technologies. It establishes a new 4-year transitional coverage period for devices designated as "breakthrough" by the Secretary of Health and Human Services, ensuring beneficiaries can access these products more quickly. During this period, Medicare will cover these devices unless they are used outside their Food and Drug Administration (FDA)-approved labeling or are found to pose an undue risk of harm. To qualify for this transitional coverage, a device must meet specific criteria, including having received priority review from the FDA. The Secretary must also determine that the device would otherwise be covered under Medicare Parts A or B and does not present an undue risk of harm that outweighs its potential clinical benefits. The bill mandates a clear process for manufacturers to apply for this designation, requiring a determination within six months and an explanation if the designation is denied. Furthermore, the legislation requires the Secretary to make a final National Coverage Determination (NCD) for a breakthrough device before the end of its 4-year transitional coverage period. This ensures a permanent coverage decision is in place following the temporary period, provided the NCD request was submitted sufficiently in advance. The bill also appropriates $10 million annually from fiscal years 2025 through 2030 to the Centers for Medicare & Medicaid Services to implement these new provisions.
View Full Text

Suggested Questions

Get AI-generated questions to help you understand this bill better

Timeline

Bill from Previous Congress

HR 116-5333
Ensuring Patient Access to Critical Breakthrough Products Act of 2019

Bill from Previous Congress

HR 117-4043
Ensuring Patient Access to Critical Breakthrough Products Act of 2021

Bill from Previous Congress

HR 118-1691
Ensuring Patient Access to Critical Breakthrough Products Act of 2024
May 12, 2025

Latest Companion Bill Action

S 119-1717
Introduced in Senate
Sep 15, 2025
Introduced in House
Sep 15, 2025
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sep 17, 2025
Committee Consideration and Mark-up Session Held
Sep 17, 2025
Ordered to be Reported in the Nature of a Substitute (Amended) by the Yeas and Nays: 37 - 3.
  • Bill from Previous Congress

    HR 116-5333
    Ensuring Patient Access to Critical Breakthrough Products Act of 2019


  • Bill from Previous Congress

    HR 117-4043
    Ensuring Patient Access to Critical Breakthrough Products Act of 2021


  • Bill from Previous Congress

    HR 118-1691
    Ensuring Patient Access to Critical Breakthrough Products Act of 2024


  • May 12, 2025

    Latest Companion Bill Action

    S 119-1717
    Introduced in Senate


  • September 15, 2025
    Introduced in House


  • September 15, 2025
    Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.


  • September 17, 2025
    Committee Consideration and Mark-up Session Held


  • September 17, 2025
    Ordered to be Reported in the Nature of a Substitute (Amended) by the Yeas and Nays: 37 - 3.
Blake D. Moore

Blake D. Moore

Republican Representative

Utah

Cosponsors (37)
Celeste Maloy (Republican)Chris Pappas (Democratic)Chrissy Houlahan (Democratic)Darren Soto (Democratic)Mike Carey (Republican)Claudia Tenney (Republican)Terri A. Sewell (Democratic)Aaron Bean (Republican)Jimmy Panetta (Democratic)J. Luis Correa (Democratic)Steve Cohen (Democratic)Suzan K. DelBene (Democratic)Angie Craig (Democratic)Earl L. "Buddy" Carter (Republican)Jake Auchincloss (Democratic)Ted Lieu (Democratic)Rudy Yakym (Republican)Gus M. Bilirakis (Republican)Daniel Meuser (Republican)Carol D. Miller (Republican)Marilyn Strickland (Democratic)John Joyce (Republican)Cliff Bentz (Republican)Brittany Pettersen (Democratic)Ami Bera (Democratic)Brian K. Fitzpatrick (Republican)Deborah K. Ross (Democratic)Lori Trahan (Democratic)Burgess Owens (Republican)Randy K. Sr. Weber (Republican)Josh Gottheimer (Democratic)Zoe Lofgren (Democratic)Michael Lawler (Republican)Bradley Scott Schneider (Democratic)Michelle Fischbach (Republican)Jennifer A. Kiggans (Republican)Nicole Malliotakis (Republican)

Ways and Means Committee, Energy and Commerce Committee

Health

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
Congressional oversightDrug safety, medical device, and laboratory regulationHealth care costs and insuranceHealth care coverage and accessHealth programs administration and fundingHealth technology, devices, suppliesMedicare