Loading…
H.R. 5509119th CongressIn committeeLatest action Sep 19, 2025Decoded by AI · checked against the record
The plain-language version leads. The official text is always the reference.
Employer health plans would have to let patients skip "step therapy" drug requirements under certain conditions and respond within 72 hours.
50-second read · 4 questions answered below
This bill sets rules for employer-sponsored health plans that require patients to try cheaper drugs before covering the one their doctor prescribed. Plans would need a formal process for patients or doctors to request an exception, with a response required within 72 hours, or 24 hours in urgent situations. Exceptions must be approved when prior drugs failed, are unsafe, or when delay could cause serious harm, and approved coverage must last at least one year.
This affects patients enrolled in employer-sponsored health insurance plans and the doctors who treat them. Health plans covered by this bill would also be required to report exception data annually to the federal government.
Without a required exception process, patients whose doctors prescribed a specific drug may face delays or denials getting that medication. This bill would create a legal requirement for plans to respond and decide within set time limits.
AI-drafted summary. Verify it against the official text before you act on it. Read the official bill on Congress.gov
Right now: a House committee is reviewing it. If the Senate changes it, it goes back to the House before reaching the President.
Latest action: — Referred to the House Committee on Education and Workforce.