H.R. 9192 — Prior Authorization Reform for Autoimmune and Blood Disorders Act

This section requires group health plans and health insurance issuers to cover any drug indicated and prescribed for an autoimmune disease, hemophilia, or Von Willebrand disease, regardless of whether the drug is dispensed by a pharmacy or furnished incident to another covered service. It prohibits requiring prior authorization for such a drug more than once in any 12-month period, unless the drug is typically used for 12 months or less, is an opioid, benzodiazepine, barbiturate, or carisoprodol, or requires a risk evaluation and mitigation strategy; the requirements apply to plan years beginning on or after January 1, 2027.