Patient Access to Autoimmune Treatments Act; PAAT Act
Summary
The Patient Access to Autoimmune Treatments Act (PAAT Act) aims to amend Title XVIII of the Social Security Act, mandating Medicare Part D coverage for drugs treating autoimmune diseases, hemophilia, and Von Willebrand disease. This bill ensures that prescription drug plans include these medications in their covered drug lists starting in 2027. It also restricts the use of prior authorization for these drugs, limiting it to once per 12-month period unless specific conditions are met.
The bill specifically targets autoimmune diseases and certain blood disorders, aiming to improve access to necessary treatments for affected individuals. The Act prohibits prior authorization for these drugs more than once per year, with exceptions for drugs typically used for short durations, opioids, benzodiazepines, barbiturates, carisoprodol, or drugs requiring risk evaluation and mitigation strategies.
Introduced in the House of Representatives, the bill has been referred to the Committees on Energy and Commerce and Ways and Means for consideration.
Expected Effects
The PAAT Act will likely increase access to medications for individuals with autoimmune diseases, hemophilia, and Von Willebrand disease who are enrolled in Medicare Part D. This will reduce the financial burden on patients and potentially improve their health outcomes.
The limitation on prior authorization requirements could streamline the process for patients to receive necessary medications, reducing delays and administrative burdens for both patients and healthcare providers. The changes will primarily affect PDP sponsors and MA organizations offering prescription drug plans under Medicare Part D.
Potential Benefits
- Increased access to necessary medications for individuals with autoimmune diseases and blood disorders.
- Reduced financial burden on patients requiring these treatments.
- Streamlined access to medications through limitations on prior authorization.
- Improved health outcomes due to better medication adherence.
- Reduced administrative burden for healthcare providers.
Potential Disadvantages
- Potential increase in Medicare Part D costs, which could lead to higher premiums for all beneficiaries.
- Possible increased utilization of certain medications, which may not always be medically necessary.
- Administrative challenges for PDP sponsors and MA organizations in implementing the new requirements.
- Risk of unintended consequences due to the limitations on prior authorization, such as increased drug misuse.
- Potential for pharmaceutical companies to increase drug prices in response to guaranteed coverage.
Constitutional Alignment
The PAAT Act aligns with the general welfare clause of the US Constitution, as it aims to promote the health and well-being of individuals with autoimmune diseases and blood disorders. The Act falls under the legislative powers granted to Congress in Article I, Section 8, which includes the power to provide for the general welfare of the United States through taxation and spending.
The Act does not appear to infringe on any specific constitutional rights or liberties. It is within the purview of Congress to regulate healthcare and provide for the needs of specific populations through Medicare.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).