Congress strips insurers' power to delay care—doctors decide now
H.R. 639 — Doctor Knows Best Act of 2025 · Filed by Jefferson Van Drew (R-NJ) · Introduced Jan 22, 2025 · Referred to committee
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What it does
This bill prohibits health insurance plans (private and federal) from requiring prior authorization, step therapy, or medical necessity reviews before covering treatments. Doctors and patients would decide on care; insurers cannot delay or deny coverage based on pre-approval requirements. The ban applies to all covered services starting January 1, 2026.
Why we flagged it
The bill's operative mechanism is a blanket prohibition on three insurer cost-control tools (prior authorization, step therapy, medical necessity review). It is not a subsidy, carve-out, or narrow exemption — it is a broad restriction on insurer power applied uniformly across all covered services and all plan types.
What the text implies
- Eliminates insurer ability to enforce step-therapy (fail-first) protocols, which currently require patients to try cheaper drugs before accessing more expensive ones; this may increase drug costs and total plan spending.
- Removes medical necessity reviews, which currently allow insurers to deny coverage for off-label uses or experimental treatments; patients gain access but plans lose a tool to exclude unproven therapies.
The full analysis lists 5 implications of this text.
Who stands to gain
pharmaceutical companies (step-therapy removal increases drug utilization); specialty care providers (fewer authorization barriers to referral); medical device manufacturers (medical necessity reviews eliminated)