Medicare now must cover autoimmune drugs, limits insurer delays
H.R. 5467 — PAAT Act · Filed by Julie Johnson (D-TX) · 5 cosponsors · Introduced Sep 18, 2025 · Referred to committee
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What it does
This bill requires Medicare Part D prescription drug plans to cover all FDA-approved drugs for autoimmune diseases, hemophilia, and Von Willebrand disease starting in 2027, and prohibits insurers from requiring prior authorization for these drugs more than once per year (with narrow exceptions for short-term drugs, controlled substances, and drugs with FDA-mandated safety monitoring). The bill ensures Medicare beneficiaries with autoimmune and blood disorders have faster, more reliable access to their prescribed treatments.
Why we flagged it
The bill's operative mechanism is a straightforward mandate: Medicare Part D plans must cover specified drugs and limit prior authorization. It is a public-health access measure, not a tax provision, subsidy, or deregulation.
What the text implies
- Pharmaceutical manufacturers of autoimmune and blood disorder drugs may see increased volume and revenue as prior authorization barriers fall, though the bill does not directly subsidize or price-protect these drugs.
- Medicare Part D insurers (PDP sponsors) face higher claims costs and reduced ability to manage formulary costs through prior authorization gatekeeping, which may increase premiums or reduce insurer margins.
The full analysis lists 4 implications of this text.
Who stands to gain
Medicare beneficiaries with autoimmune diseases and blood disorders (reduced out-of-pocket delays an; Pharmaceutical manufacturers of autoimmune and blood disorder drugs (increased volume from reduced a