A Republican bill with 38 Democratic cosponsors · See all 53 cosponsors
Last activity — Committee on Health, Education, Labor, and Pensions. Hearings held.
In committee
Introduced and handed to a committee in the chamber it started in.
The committee holds it, and most bills are never heard from again. A hearing or a committee vote would be news; silence is the usual outcome, and it kills the bill without anyone voting against it.
Its path through Congress
- Introduced
- In Committee
What this bill would do
This bill amends the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance coverage to provide a clear and transparent exceptions process for medication step therapy protocols. It outlines specific clinical circumstances under which a patient or their doctor can request and be granted an exception to try a prescribed drug without first trying alternative preferred drugs. The legislation sets strict timelines for health plans to respond to these exception requests, ranging from standard reviews within 72 hours to expedited reviews within 24 hours for urgent health situations. Once an exception is granted, the coverage for the requested drug must remain in effect for at least one year. Additionally, plans are required to report annually on the number of exception requests they receive, approve, and deny, and the Secretary must submit these findings to Congress.
Yes· 3 of 23
- Scored +8
Does this make health care easier to get in general?
Directly improves access to specific, medically necessary medications by streamlining the step therapy exception process.
- Scored +7
Would people with disabilities be better off under this?
Specifically provides exceptions to maintain functional ability in daily living and work.
- Scored +6
Would union members be better off under this?
Union members typically have robust employer-sponsored group health plans that are subject to these ERISA amendments.
The opposite· 3 of 4
- Scored -2
Would business owners be better off under this?
Employers providing group health plans may face slightly higher administrative and drug costs.
- Scored -2
Does this protect people from being watched or searched?
May require disclosure of sensitive health records as a condition for accessing necessary medication.
- Scored -2
Does this lower what people pay for private health insurance?
Increased coverage of non-preferred drugs through exceptions may lead to higher costs for insurers, potentially affecting premiums.
Who it would affect, and how
Potential Positive Impacts for People
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Section 713A(a)(1) requires group health plans and health insurance issuers to implement a clear, prompt, and transparent process for participants, beneficiaries, or their doctors to request exceptions to medication step therapy protocols. This helps patients and their providers easily navigate insurance rules when seeking necessary medications.
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Section 713A(b) establishes specific circumstances for exception approval, such as when required treatments have already been ineffective, when delays would lead to severe or irreversible consequences, or when required treatments are contraindicated or likely to cause harm. This protects individuals from being forced to take drugs that do not work for them or that could make their health conditions worse.
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Section 713A(d) sets strict deadlines for health plans to make determinations on exception requests, requiring standard responses within 72 hours and expedited responses within 24 hours in urgent situations where health, function, or pain is at risk. This ensures patients do not face dangerous delays in obtaining their prescribed treatments.
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Section 713A(e) states that once an exception to a step therapy protocol is granted, coverage for the requested drug must remain in effect for at least one year. This provides patients with stability so they do not have to repeatedly fight for the same medication approval every few months.
Potential Negative Impacts for People
- Section 713A(h)(1) requires health plans and insurance issuers to collect and report extensive data regarding exception requests, denials, appeals, and medical conditions to the Secretary. While this is intended for oversight and reporting to Congress, the administrative burden and costs associated with tracking and reporting this detailed information could potentially be passed down to plan participants in the form of higher costs or increased administrative red tape.
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Tap or hover a score for the reason it gave.
- Demographic And Interest Groups
- Would people with disabilities be better off under this? — Specifically provides exceptions to maintain functional ability in daily living and work. Would union members be better off under this? — Union members typically have robust employer-sponsored group health plans that are subject to these ERISA amendments. Would high-income households be better off under this? — Reduces the potential cost and health risk associated with being forced to try ineffective preferred drugs. Would households on low incomes be better off under this? — Reduces the potential cost and health risk associated with being forced to try ineffective preferred drugs. Would middle-income households be better off under this? — Reduces the potential cost and health risk associated with being forced to try ineffective preferred drugs. Would Black Americans be better off under this? — Increases access to medically necessary treatments for chronic conditions across all demographics. Would Asian Americans be better off under this? — Increases access to medically necessary treatments for chronic conditions across all demographics. Would children be better off under this? — Children with chronic conditions benefit from faster access to an effective drug without trial-and-error. Would Hispanic Americans be better off under this? — Increases access to medically necessary treatments for chronic conditions across all demographics. Would LGBTQ people be better off under this? — Improves access to specialized medications, including those for gender-affirming care if they fall under step therapy. Would men be better off under this? — Increases access to necessary medications for chronic conditions. Would people in middle age be better off under this? — Improves access to necessary medications for those in employer-sponsored plans. Would Native Americans be better off under this? — Increases access to medically necessary treatments for chronic conditions across all demographics. Would white Americans be better off under this? — Increases access to medically necessary treatments for chronic conditions across all demographics. Would women be better off under this? — Increases access to necessary medications for chronic conditions. Would people in their twenties and thirties be better off under this? — Improves access to necessary medications for those in employer-sponsored plans. Would business owners be better off under this? — Employers providing group health plans may face slightly higher administrative and drug costs.
- Governance And Ideology
- Does this protect the right to fair treatment by the courts? — Establishes clear timelines and criteria for the adjudication of medication exceptions. Does this make what the government does easier for the public to see? — Requires annual reporting of exception requests and results to the Secretary of Labor and the public. Does this give the federal government more power? — Adds federal mandates to the ERISA framework regarding health plan requirements. Does this protect people from being watched or searched? — May require disclosure of sensitive health records as a condition for accessing necessary medication.
- Healthcare
- Does this make health care easier to get in general? — Directly improves access to specific, medically necessary medications by streamlining the step therapy exception process. Does this make mental health care easier to get? — Allows exceptions for medications necessary for maintaining functional ability and treating mental health conditions. Does this lower what people pay for private health insurance? — Increased coverage of non-preferred drugs through exceptions may lead to higher costs for insurers, potentially affecting premiums.
- Social Issues And Justice
- Does this expand the rights of people with disabilities? — Helps individuals with chronic disabilities maintain stability and functional ability through specialized medication.
- Economy And Finance
- Does this give people more protection from unfair business practices? — Increases patient protections against restrictive drug therapy protocols in group health plans.
- Education And Technology
- Does this give people more control over their personal data? — Requires disclosure of private medical records to insurers to qualify for medication exceptions.
- 11/10/2026
- 1 Cosponsor added.
- 9/24/2026
- 1 Cosponsor added.
- 9/17/2026
- 1 Cosponsor added.
- 7/29/2026
- 1 Cosponsor added.
- 7/28/2026
- 3 Cosponsors added.
- 6/15/2026
- 1 Cosponsor added.
- 6/9/2026
- 1 Cosponsor added.
- 6/2/2026
- 1 Cosponsor added.
- 4/28/2026
- 1 Cosponsor added.
- 3/25/2026
- 1 Cosponsor added.
- 3/19/2026
- Committee on Health, Education, Labor, and Pensions. Hearings held.
- 3/17/2026
- 1 Cosponsor added.
- 3/10/2026
- 2 Cosponsors added.
- 3/5/2026
- 2 Cosponsors added.
- 3/2/2026
- 1 Cosponsor added.
- 2/25/2026
- 1 Cosponsor added.
- 2/24/2026
- 1 Cosponsor added.
- 2/12/2026
- 1 Cosponsor added.
- 12/16/2025
- 1 Cosponsor added.
- 12/9/2025
- 1 Cosponsor added.
- 12/4/2025
- 1 Cosponsor added.
- 11/19/2025
- 1 Cosponsor added.
- 10/27/2025
- 1 Cosponsor added.
- 10/23/2025
- 2 Cosponsors added.
- 10/21/2025
- 1 Cosponsor added.
- 10/7/2025
- 3 Cosponsors added.
- 10/1/2025
- 3 Cosponsors added.
- 9/18/2025
- Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- 18 Cosponsors added.
- Introduced in Senate
One bill Congress.gov lists as related to this one — companions in the other chamber, earlier versions, and bills this one absorbed or was folded into.
Angela AlsobrooksDemocrat · Maryland
Tammy BaldwinDemocrat · Wisconsin
John BoozmanRepublican · Arkansas
Michael BennetDemocrat · Colorado
Richard BlumenthalDemocrat · Connecticut
Cory BookerDemocrat · New Jersey
Ted BuddRepublican · North Carolina
Maria CantwellDemocrat · Washington
Susan CollinsRepublican · Maine
Shelley CapitoRepublican · West Virginia
Christopher CoonsDemocrat · Delaware
Kevin CramerRepublican · North Dakota
Catherine Cortez MastoDemocrat · Nevada
Tammy DuckworthDemocrat · Illinois
Deb FischerRepublican · Nebraska
John FettermanDemocrat · Pennsylvania
Kirsten GillibrandDemocrat · New York
Ruben GallegoDemocrat · Arizona
John HickenlooperDemocrat · Colorado
Mazie HironoDemocrat · Hawaii
Martin HeinrichDemocrat · New Mexico
Maggie HassanDemocrat · New Hampshire
Cindy Hyde-SmithRepublican · Mississippi
Jon HustedRepublican · Ohio
James JusticeRepublican · West Virginia
Amy KlobucharDemocrat · Minnesota
Mark KellyDemocrat · Arizona
Angus KingIndependent · Maine
Timothy KaineDemocrat · Virginia
Andy KimDemocrat · New Jersey
Jerry MoranRepublican · Kansas
Patty MurrayDemocrat · Washington
Christopher MurphyDemocrat · Connecticut
Jeff MerkleyDemocrat · Oregon
Roger MarshallRepublican · Kansas
Jon OssoffDemocrat · Georgia
Alex PadillaDemocrat · California
Gary PetersDemocrat · Michigan
Jacky RosenDemocrat · Nevada
Adam SchiffDemocrat · California
Jeanne ShaheenDemocrat · New Hampshire
Dan SullivanRepublican · Alaska
Tina SmithDemocrat · Minnesota
Elissa SlotkinDemocrat · Michigan
Thomas TillisRepublican · North Carolina
Chris Van HollenDemocrat · Maryland
Roger WickerRepublican · Mississippi
Ron WydenDemocrat · Oregon
Raphael WarnockDemocrat · Georgia
Peter WelchDemocrat · Vermont
Sheldon WhitehouseDemocrat · Rhode Island
Mark WarnerDemocrat · Virginia
Elizabeth WarrenDemocrat · Massachusetts