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Bill

HF 3869

Prior authorization of drugs the enrollee has been prescribed prohibited for at least six months.

2025-2026 Regular Session Introduced by Kristin Bahner and 7 co-sponsors

Bill prohibits insurers from requiring prior authorization for medications patients have taken continuously for six months, streamlining refills for stable chronic conditions.

Introduction and first reading, referred to Commerce Finance and Policy
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Bill Summary · HF 3869

Legislative bill overview

HF 3869 prohibits health insurance companies from requiring prior authorization for medications that an enrollee has been continuously prescribed for at least six months. Once a patient has been on a stable medication regimen for this timeframe, insurers would be required to cover refills and continuations without requiring physicians to resubmit authorization requests for each refill cycle.

Why is this important

Prior authorization delays can prevent patients from accessing needed medications, potentially worsening health outcomes and forcing patients into emergency care. This bill addresses a known pain point where stable patients on chronic medications face repeated administrative barriers despite demonstrated medical necessity. For conditions like diabetes, hypertension, or mental health disorders, continuous uninterrupted medication access is clinically important.

Potential points of contention

  • Cost implications: Insurers argue prior authorization controls unnecessary drug spending; opponents counter that most denials occur on established therapies where medical necessity is already proven
  • Implementation burden: Questions about tracking six-month thresholds, handling mid-cycle prescription changes, and enforcement mechanisms across different insurance plans
  • Scope definition: Unclear whether "continuously prescribed" allows for brief gaps (vacations, supply chains) or requires perfect compliance; also undefined which drug categories are covered

Compiled from official sources — confirm details with the bill’s official record.

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