Prohibiting prior authorization requirements, utilization management techniques, and medical necessity reviews

(a) Private insurers Subpart II of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–11 et seq.) is amended by adding at the end the following new section: 2730. Prohibition on prior authorization requirements, utilization management techniques, and medical necessity reviews A group health plan, and a health insurance issuer offering group or individual health insurance coverage, may not impose any prior authorization requirement, any utilization management technique (including any step therapy or fail-first protocol), or any medical necessity review on any item or service for which benefits are available under such plan or coverage.. (b) Federal health care programs Beginning January 1, 2026, a Federal health care program (as defined in section 1128B of the Social Security Act (42 U.S.C. 1320a–7b) and the health program established under chapter 89 of title 5, United States Code, including a State or any entity carrying out such Federal health care program or health program, may not impose any prior authorization requirement, any utilization management technique (including any step therapy or fail-first protocol), or any medical necessity review on any item or service for which benefits are available under Federal health care program or health program (as applicable). (c) Effective date The amendment made by subsection (a) shall apply with respect to plan years beginning on or after January 1, 2026.