Energy and Commerce Committee, Oversight and Government Reform Committee
Introduced
In Committee
On Floor
Passed Chamber
Enacted
This bill proposes a significant change to health care administration by prohibiting specific practices across various health coverage entities. It mandates that group health plans , health insurance issuers , and Federal health care programs cannot impose prior authorization requirements , utilization management techniques , or medical necessity reviews on any covered item or service. The prohibition on utilization management techniques explicitly includes practices like step therapy and fail-first protocols . For private insurers, these changes will apply to plan years beginning on or after January 1, 2026. Federal health care programs, including state-administered ones, will be subject to these restrictions starting January 1, 2026, aiming to streamline access to care by removing these administrative hurdles.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Oversight and Government Reform, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Oversight and Government Reform, 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.
Health
Health care costs and insuranceHealth care coverage and access
Doctor Knows Best Act of 2025
USA119th CongressHR-639| House
| Updated: 1/22/2025
This bill proposes a significant change to health care administration by prohibiting specific practices across various health coverage entities. It mandates that group health plans , health insurance issuers , and Federal health care programs cannot impose prior authorization requirements , utilization management techniques , or medical necessity reviews on any covered item or service. The prohibition on utilization management techniques explicitly includes practices like step therapy and fail-first protocols . For private insurers, these changes will apply to plan years beginning on or after January 1, 2026. Federal health care programs, including state-administered ones, will be subject to these restrictions starting January 1, 2026, aiming to streamline access to care by removing these administrative hurdles.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Oversight and Government Reform, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Oversight and Government Reform, 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.