I 
119TH CONGRESS 
1ST SESSION H. R. 5467 
To amend title XVIII of the Social Security Act to require coverage of 
drugs for autoimmune diseases and certain blood disorders under Medi-
care part D. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 18, 2025 
Ms. JOHNSON of Texas (for herself and Mr. KENNEDY of Utah) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committee on Ways and Means, for 
a period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to require 
coverage of drugs for autoimmune diseases and certain 
blood disorders under Medicare part D. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Patient Access to 
Autoimmune Treatments Act’’ or the ‘‘PAAT Act’’. 
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SEC. 2. REQUIRING COVERAGE OF DRUGS FOR AUTO-
IMMUNE DISEASES AND CERTAIN BLOOD DIS-
ORDERS UNDER MEDICARE PART D. 
Section 1860D–4 of the Social Security Act (42 
U.S.C. 1395w–104) is amended— 
(1) in subsection (b)(3), by adding at the end 
the following new subparagraph: 
‘‘(J) REQUIRED
INCLUSION
OF
CERTAIN 
DRUGS
FOR
AUTOIMMUNE
DISEASES
AND 
BLOOD DISORDERS.— 
‘‘(i) IN
GENERAL.—For 2027 and 
each subsequent year, a PDP sponsor of-
fering a prescription drug plan shall in-
clude each covered part D drug that is an 
autoimmune or blood disorder drug de-
scribed in clause (ii). 
‘‘(ii) AUTOIMMUNE
OR
BLOOD
DIS-
ORDER DRUG.—For purposes of clause (i), 
a drug described in this clause is a covered 
part D drug indicated and prescribed for 
the treatment of an autoimmune disease, 
hemophilia, or Von Willebrand disease.’’; 
and 
(2) in subsection (c)— 
(A) by redesignating paragraph (6), as 
added by section 50354 of division E of the Bi-
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partisan Budget Act of 2018 (Public Law 115– 
123), as paragraph (7); and 
(B) by adding at the end the following new 
paragraph: 
‘‘(8) PROHIBITION ON USE OF PRIOR AUTHOR-
IZATION FOR CERTAIN AUTOIMMUNE OR BLOOD DIS-
ORDER
DRUGS.—For plan years beginning on or 
after January 1, 2027, a PDP sponsor offering a 
prescription drug plan (and an MA organization of-
fering an MA–PD plan) may not require, with re-
spect to an individual enrolled under such plan, that 
prior authorization for an autoimmune or blood dis-
order drug (as described in subsection (b)(3)(J)(ii)) 
be obtained more than once during any 12-month 
period unless such drug is— 
‘‘(A) typically used for a period of 12 
months or less; 
‘‘(B) an opioid, a benzodiazepine, a bar-
biturate, or carisoprodol; or 
‘‘(C) a drug with respect to which a risk 
evaluation and mitigation strategy is required 
under Section 505–1 of the Federal Food, 
Drug, and Cosmetic Act.’’. 
Æ 
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