II 

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. LUJA ́N, 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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. ELECTRONIC PRIOR AUTHORIZATION FOR PRE4 SCRIPTION DRUGS. 

5 (a) PHSA.—Part D of title XXVII of the Public 

6 Health Service Act (42 U.S.C. 300gg–111 et seq.) is 

7 amended by adding at the end the following: 


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1 ‘‘SEC. 2799A–11. ELECTRONIC PRIOR AUTHORIZATION FOR 

2 PRESCRIPTION DRUGS. 

3 ‘‘(a) IN GENERAL.—For plan years beginning on or 

4 after January 1, 2027, a group health plan or health in5 surance issuer offering group or individual health insur6 ance coverage shall provide for the secure electronic trans7 mission of— 

8 ‘‘(1) a prior authorization request from the pre9 scribing health care professional for coverage of a 

10 prescription drug for a participant, beneficiary, or 

11 enrollee in such plan or coverage to such plan or 

12 issuer; and 

13 ‘‘(2) a response, in accordance with this section, 

14 from such plan or issuer to such professional. 

15 ‘‘(b) ELECTRONIC TRANSMISSION.— 

16 ‘‘(1) EXCLUSIONS.—For purposes of this sec17 tion, a facsimile, a proprietary payer portal that 

18 does not meet standards specified by the Secretary, 

19 or an electronic form shall not be treated as an elec20 tronic transmission described in subsection (a). 

21 ‘‘(2) STANDARDS.—In order to be treated, for 

22 purposes of this section, as an electronic trans23 mission described in subsection (a), such trans24 mission shall comply with technical standards adopt25 ed by the Secretary, in consultation with the Sec26 retary of Labor, the Secretary of the Treasury, the 


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1 National Council for Prescription Drug Programs, 

2 other standard-setting organizations as determined 

3 appropriate by the Secretary, and stakeholders, in4 cluding group health plans and health insurance 

5 issuers offering group or individual health insurance 

6 coverage, health care professionals, and health infor7 mation technology software vendors. 

8 ‘‘(3) APPLICATION.—Notwithstanding any other 

9 provision of law, for purposes of this section, the 

10 Secretary may require the use of standards adopted 

11 under paragraph (2) in lieu of any other applicable 

12 standards for an electronic transmission described in 

13 subsection (a) for prescription drugs for a partici14 pant, beneficiary, or enrollee described in such sub15 section.’’. 

16 (b) ERISA.— 

17 (1) IN GENERAL.—Subpart B of part 7 of sub18 title B of title I of the Employee Retirement Income 

19 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 

20 amended by adding at the end the following: 

21 ‘‘SEC. 726. ELECTRONIC PRIOR AUTHORIZATION FOR PRE22 SCRIPTION DRUGS. 

23 ‘‘(a) IN GENERAL.—For plan years beginning on or 

24 after January 1, 2027, a group health plan or health inVerDate Sep 11 2014 19:35 Jun 18, 2024 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4349.IS S4349

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1 surance issuer offering group health insurance coverage 

2 shall provide for the secure electronic transmission of— 

3 ‘‘(1) a prior authorization request from the pre4 scribing health care professional for coverage of a 

5 prescription drug for a participant or beneficiary in 

6 such plan or coverage to such plan or issuer; and 

7 ‘‘(2) a response, in accordance with this section, 

8 from such plan or issuer to such professional. 

9 ‘‘(b) ELECTRONIC TRANSMISSION.— 

10 ‘‘(1) EXCLUSIONS.—For purposes of this sec11 tion, a facsimile, a proprietary payer portal that 

12 does not meet standards specified by the Secretary, 

13 or an electronic form shall not be treated as an elec14 tronic transmission described in subsection (a). 

15 ‘‘(2) STANDARDS.—In order to be treated, for 

16 purposes of this section, as an electronic trans17 mission described in subsection (a), such trans18 mission shall comply with technical standards adopt19 ed by the Secretary, in consultation with the Sec20 retary of Health and Human Services, the Secretary 

21 of the Treasury, the National Council for Prescrip22 tion Drug Programs, other standard-setting organi23 zations as determined appropriate by the Secretary, 

24 and stakeholders, including group health plans and 

25 health insurance issuers offering group health insurVerDate Sep 11 2014 19:35 Jun 18, 2024 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4349.IS S4349

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1 ance coverage, health care professionals, and health 

2 information technology software vendors. 

3 ‘‘(3) APPLICATION.—Notwithstanding any other 

4 provision of law, for purposes of this section, the 

5 Secretary may require the use of standards adopted 

6 under paragraph (2) in lieu of any other applicable 

7 standards for an electronic transmission described in 

8 subsection (a) for prescription drugs for a partici9 pant or beneficiary described in such subsection.’’. 

10 (2) CLERICAL AMENDMENT.—The table of con11 tents in section 1 of the Employee Retirement In12 come Security Act of 1974 (29 U.S.C. 1001 et seq.) 

13 is amended by inserting after the item relating to 

14 section 725 the following: 

‘‘Sec. 726. Electronic prior authorization for prescription drugs.’’. 

15 (c) IRC.— 

16 (1) IN GENERAL.—Subchapter B of chapter 

17 100 of the Internal Revenue Code of 1986 is amend18 ed by adding at the end the following: 

19 ‘‘SEC. 9826. ELECTRONIC PRIOR AUTHORIZATION FOR PRE20 SCRIPTION DRUGS. 

21 ‘‘(a) IN GENERAL.—For plan years beginning on or 

22 after January 1, 2027, a group health plan shall provide 

23 for the secure electronic transmission of— 

24 ‘‘(1) a prior authorization request from the pre25 scribing health care professional for coverage of a 


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1 prescription drug for a participant or beneficiary in 

2 such plan to such plan; and 

3 ‘‘(2) a response, in accordance with this section, 

4 from such plan to such professional. 

5 ‘‘(b) ELECTRONIC TRANSMISSION.— 

6 ‘‘(1) EXCLUSIONS.—For purposes of this sec7 tion, a facsimile, a proprietary payer portal that 

8 does not meet standards specified by the Secretary, 

9 or an electronic form shall not be treated as an elec10 tronic transmission described in subsection (a). 

11 ‘‘(2) STANDARDS.—In order to be treated, for 

12 purposes of this section, as an electronic trans13 mission described in subsection (a), such trans14 mission shall comply with technical standards adopt15 ed by the Secretary of Health and Human Services, 

16 in consultation with the Secretary of Labor, the Na17 tional Council for Prescription Drug Programs, 

18 other standard-setting organizations as determined 

19 appropriate by the Secretary, and stakeholders, in20 cluding group health plans, health care profes21 sionals, and health information technology software 

22 vendors. 

23 ‘‘(3) APPLICATION.—Notwithstanding any other 

24 provision of law, for purposes of this section, the 

25 Secretary may require the use of standards adopted 


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1 under paragraph (2) in lieu of any other applicable 

2 standards for an electronic transmission described in 

3 subsection (a) for prescription drugs for a partici4 pant or beneficiary described in such subsection.’’. 

5 (2) CLERICAL AMENDMENT.—The table of sec6 tions for subchapter B of chapter 100 of the Inter7 nal Revenue Code of 1986 is amended by adding at 

8 the end the following new item: 

‘‘Sec. 9826. Electronic prior authorization for prescription drugs.’’. 

Æ 


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