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HR 9192

Prior Authorization Reform for Autoimmune and Blood Disorders Act

119th Congress Introduced by Julie Johnson and 1 co-sponsor

The bill would require ERISA group health plans, federal programs, and related tax provisions to cover drugs indicated for autoimmune diseases and certain blood disorders.

Introduced in House
0
WeVote Research Nonpartisan
Bill Summary · HR 9192

Summary of HR 9192 (119th Congress)

Purpose and intent

HR 9192 seeks to expand health insurance coverage for drugs that treat autoimmune diseases and certain blood disorders. Specifically, the bill would require coverage for these drugs under several major U.S. health coverage frameworks, including employee health plans, public health program requirements, and the tax code’s treatment of health benefits. The overarching aim is to ensure individuals with autoimmune conditions and specified hematologic disorders have access to medically necessary medications without facing uncovered costs.

Key provisions and changes

  • Coverage requirements across programs:

    • Amendments to the Employee Retirement Income Security Act of 1974 (ERISA) to mandate that group health plans cover drugs indicated for autoimmune diseases and specified blood disorders.
    • Amendments to the Public Health Service Act (title XXVII) to require similar coverage for these drugs in the public health and federal program contexts.
    • Amendments to the Internal Revenue Code of 1986 to reflect coverage-related requirements in the tax treatment of health benefits, reinforcing or facilitating compliance within employer-sponsored plans and related arrangements.

  • Drugs covered:

    • Drugs indicated for treatment of autoimmune diseases (e.g., conditions where the immune system attacks the body) and certain blood disorders. The bill specifies that covered medications are those indicated for treatment of these conditions, aiming to reduce barriers to access.

  • Scope and implementation:

    • The bill would apply to plans and coverage governed by ERISA, federal health programs, and related tax provisions, creating a unified standard across multiple statutory regimes.
    • It is intended to align plan design and reimbursement practices with coverage for the indicated therapies.

Who would be affected

  • Individuals enrolled in group health plans governed by ERISA would gain mandated coverage for the specified autoimmune and blood disorder drugs.
  • Beneficiaries of federal health programs and individuals seeking treatment under provisions governed by the Public Health Service Act would see expanded or clarified coverage requirements.
  • Employers and plan sponsors would need to ensure their health plans comply with the new coverage requirements to avoid noncompliance under ERISA and related statutes.
  • Pharmaceutical providers and pharmacies may experience changes in reimbursement patterns and formulary considerations as plans adjust to the mandated coverage.

Procedural and timeline aspects

  • Introduction and referral:
    • Introduced in the House and referred on 2026-06-08 to the Committee on Energy and Commerce, with parallel referrals to the Education and Workforce Committee and the Ways and Means Committee, for provisions within their jurisdictions.
  • Committee action:
    • The action history indicates standard committee review processes, with consideration of provisions falling under each committee’s jurisdiction.
  • Sponsor details:
    • Primary sponsors and co-sponsors include:
    • Co-sponsor: Mike Lawler
    • Co-sponsor: Julie Johnson

Notes and considerations

  • The bill’s impact will depend on the final text, including any definitions (e.g., what constitutes “drugs indicated for treatment” of the specified conditions), delineation of payer types (e.g., whether grandfathered plans or self-insured plans are fully covered), cost-sharing requirements (deductibles, copays, coinsurance), and any transition or phase-in periods.
  • As with similar coverage-mandating legislation, potential implications include increased premium costs for some plans, administrative changes for employers and insurers, and enhanced access to targeted therapies for patients with autoimmune diseases and certain blood disorders.

If you’d like, I can compare HR 9192 to existing coverage mandates or summarize potential fiscal impacts based on typical compliance costs and historical data from analogous policy changes.

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

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