Prior Authorization Relief Act (S 3762)

Summary

The Prior Authorization Relief Act is a bill introduced in the U.S. Senate in February 2026. The key provisions and impacts of this bill are:

Purpose and Intent

• The bill aims to reform the prior authorization process under the Medicare Advantage program.
• It seeks to standardize prior authorization requirements across Medicare Advantage plans and exempt certain providers from those requirements.

Key Provisions

1. Audit of Prior Authorization Requirements: The Secretary of Health and Human Services must conduct an audit by January 1, 2027 to identify the top 10% most reimbursed Medicare Advantage items, services, and drugs that have sufficient clinical evidence to establish standard prior authorization policies and require an excessive number of steps.

2. Standardized Prior Authorization Requirements: By May 1, 2028, the Secretary must promulgate a final rule to standardize the prior authorization requirements, including supplemental forms, for the items, services, and drugs identified in the audit across all Medicare Advantage plans.

3. Exemption for Certain Providers: The prior authorization requirements will not apply to items/services furnished or drugs prescribed by providers participating in two-sided risk models tested or implemented under Medicare, such as Accountable Care Organizations. However, plans can request that this exemption not apply to their enrollees.

Impact

• This bill is intended to reduce administrative burden and improve access to care for Medicare Advantage enrollees by streamlining the prior authorization process.
• It could particularly benefit providers in risk-based payment arrangements, who would be exempt from the standardized prior authorization requirements.
• Medicare Advantage plans would need to adjust their prior authorization policies and processes to comply with the new standardized requirements.