Bill > HR639

This bill, called the "Doctor Knows Best Act of 2025", aims to eliminate prior authorization requirements, utilization management techniques, and medical necessity reviews for both private health insurance plans and federal health care programs starting January 1, 2026. Specifically, the bill would prohibit group health plans, health insurance issuers, and federal health care programs from applying administrative procedures that currently require healthcare providers to obtain advance approval before delivering certain medical services or treatments. These restrictions would apply to both group and individual health insurance coverage, as well as federal health programs like Medicare and Medicaid. The key terms in the bill include "prior authorization" (a process where healthcare providers must get insurance approval before performing a service), "utilization management techniques" (methods insurers use to control healthcare costs, such as step therapy where patients must try less expensive treatments first), and "medical necessity reviews" (evaluations to determine if a proposed treatment is essential and appropriate). By eliminating these requirements, the bill seeks to give healthcare providers more discretion in determining patient care and potentially reduce administrative barriers to receiving medical treatment.

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https://www.congress.gov/bill/119th-congress/house-bill/639/all-info