[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4349 Introduced in Senate (IS)]
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118th CONGRESS
2d Session
S. 4349
To require private health plans to provide for secure electronic
transmission of prior authorization requests for prescription drugs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 15, 2024
Mr. Marshall (for himself, Mr. Lujan, Mr. Wicker, Mr. Manchin, and Mr.
Whitehouse) introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To require private health plans to provide for secure electronic
transmission of prior authorization requests for prescription drugs.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. ELECTRONIC PRIOR AUTHORIZATION FOR PRESCRIPTION DRUGS.
(a) PHSA.--Part D of title XXVII of the Public Health Service Act
(42 U.S.C. 300gg-111 et seq.) is amended by adding at the end the
following:
``SEC. 2799A-11. ELECTRONIC PRIOR AUTHORIZATION FOR PRESCRIPTION DRUGS.
``(a) In General.--For plan years beginning on or after January 1,
2027, a group health plan or health insurance issuer offering group or
individual health insurance coverage shall provide for the secure
electronic transmission of--
``(1) a prior authorization request from the prescribing
health care professional for coverage of a prescription drug
for a participant, beneficiary, or enrollee in such plan or
coverage to such plan or issuer; and
``(2) a response, in accordance with this section, from
such plan or issuer to such professional.
``(b) Electronic Transmission.--
``(1) Exclusions.--For purposes of this section, a
facsimile, a proprietary payer portal that does not meet
standards specified by the Secretary, or an electronic form
shall not be treated as an electronic transmission described in
subsection (a).
``(2) Standards.--In order to be treated, for purposes of
this section, as an electronic transmission described in
subsection (a), such transmission shall comply with technical
standards adopted by the Secretary, in consultation with the
Secretary of Labor, the Secretary of the Treasury, the National
Council for Prescription Drug Programs, other standard-setting
organizations as determined appropriate by the Secretary, and
stakeholders, including group health plans and health insurance
issuers offering group or individual health insurance coverage,
health care professionals, and health information technology
software vendors.
``(3) Application.--Notwithstanding any other provision of
law, for purposes of this section, the Secretary may require
the use of standards adopted under paragraph (2) in lieu of any
other applicable standards for an electronic transmission
described in subsection (a) for prescription drugs for a
participant, beneficiary, or enrollee described in such
subsection.''.
(b) ERISA.--
(1) In general.--Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185 et seq.) is amended by adding at the end the
following:
``SEC. 726. ELECTRONIC PRIOR AUTHORIZATION FOR PRESCRIPTION DRUGS.
``(a) In General.--For plan years beginning on or after January 1,
2027, a group health plan or health insurance issuer offering group
health insurance coverage shall provide for the secure electronic
transmission of--
``(1) a prior authorization request from the prescribing
health care professional for coverage of a prescription drug
for a participant or beneficiary in such plan or coverage to
such plan or issuer; and
``(2) a response, in accordance with this section, from
such plan or issuer to such professional.
``(b) Electronic Transmission.--
``(1) Exclusions.--For purposes of this section, a
facsimile, a proprietary payer portal that does not meet
standards specified by the Secretary, or an electronic form
shall not be treated as an electronic transmission described in
subsection (a).
``(2) Standards.--In order to be treated, for purposes of
this section, as an electronic transmission described in
subsection (a), such transmission shall comply with technical
standards adopted by the Secretary, in consultation with the
Secretary of Health and Human Services, the Secretary of the
Treasury, the National Council for Prescription Drug Programs,
other standard-setting organizations as determined appropriate
by the Secretary, and stakeholders, including group health
plans and health insurance issuers offering group health
insurance coverage, health care professionals, and health
information technology software vendors.
``(3) Application.--Notwithstanding any other provision of
law, for purposes of this section, the Secretary may require
the use of standards adopted under paragraph (2) in lieu of any
other applicable standards for an electronic transmission
described in subsection (a) for prescription drugs for a
participant or beneficiary described in such subsection.''.
(2) Clerical amendment.--The table of contents in section 1
of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1001 et seq.) is amended by inserting after the item
relating to section 725 the following:
``Sec. 726. Electronic prior authorization for prescription drugs.''.
(c) IRC.--
(1) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended by adding at the end
the following:
``SEC. 9826. ELECTRONIC PRIOR AUTHORIZATION FOR PRESCRIPTION DRUGS.
``(a) In General.--For plan years beginning on or after January 1,
2027, a group health plan shall provide for the secure electronic
transmission of--
``(1) a prior authorization request from the prescribing
health care professional for coverage of a prescription drug
for a participant or beneficiary in such plan to such plan; and
``(2) a response, in accordance with this section, from
such plan to such professional.
``(b) Electronic Transmission.--
``(1) Exclusions.--For purposes of this section, a
facsimile, a proprietary payer portal that does not meet
standards specified by the Secretary, or an electronic form
shall not be treated as an electronic transmission described in
subsection (a).
``(2) Standards.--In order to be treated, for purposes of
this section, as an electronic transmission described in
subsection (a), such transmission shall comply with technical
standards adopted by the Secretary of Health and Human
Services, in consultation with the Secretary of Labor, the
National Council for Prescription Drug Programs, other
standard-setting organizations as determined appropriate by the
Secretary, and stakeholders, including group health plans,
health care professionals, and health information technology
software vendors.
``(3) Application.--Notwithstanding any other provision of
law, for purposes of this section, the Secretary may require
the use of standards adopted under paragraph (2) in lieu of any
other applicable standards for an electronic transmission
described in subsection (a) for prescription drugs for a
participant or beneficiary described in such subsection.''.
(2) Clerical amendment.--The table of sections for
subchapter B of chapter 100 of the Internal Revenue Code of
1986 is amended by adding at the end the following new item:
``Sec. 9826. Electronic prior authorization for prescription drugs.''.
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