,,ii  #aahth ,,congress  #b;d ,session  
,s4 #dcdi  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #ae1      
#bjbd,mr4 ,marshall 7for himself1 ,mr4  
,lujn1 ,mr4 ,wicker1 ,mr4 ,manchin1 and 
,mr4 ,whitehouse7 introduced the        
following bill2 which was read twice and
 referred to the ,committee on ,health1 
,education1 ,labor1 and ,pensions  ,a   
,,bill  ,to require private health plans
 to provide for secure electronic       
transmission of prior authorization     
requests for prescription drugs4  #a4   
,electronic prior authorization for     
prescription drugs  7a7 ,,phsa ,part ,d 
of title ,,xxvii of the ,public ,health 
,service ,act 7#db ,u4,s4,c4            
#cjj;gg-#aaa et seq47 is amended by     
adding at the end the following3        
#bgii;,a-#aa4 ,electronic prior         
authorization for prescription drugs    
7a7 ,in general ,for plan years         
beginning on or after ,january #a1      
#bjbg1 a group health plan or health    
insurance issuer offering group or      

individual health insurance coverage    
shall provide for the secure electronic 
transmission of-- 7#a7 a prior          
authorization request from the          
prescribing health care professional for
 coverage of a prescription drug for a  
participant1 beneficiary1 or enrollee in
 such plan or coverage to such plan or  
issuer2 and  7#b7 a response1 in        
accordance with this section1 from such 
plan or issuer to such professional4    
7b7 ,electronic transmission  7#a7      
,exclusions ,for purposes of this       
section1 a facsimile1 a proprietary     
payer portal that does not meet         
standards specified by the ,secretary1  
or an electronic form shall not be      
treated as an electronic transmission   
described in subsection 7a74  7#b7      
,standards ,in order to be treated1 for 
purposes of this section1 as an         
electronic transmission described in    
subsection 7a71 such transmission shall 
comply with technical standards adopted 
by the ,secretary1 in consultation with 

the ,secretary of ,labor1 the ,secretary
 of the ,treasury1 the ,national        
,council for ,prescription ,drug        
,programs1 other standard-setting       
organizations as determined appropriate 
by the ,secretary1 and stakeholders1    
including group health plans and health 
insurance issuers offering group or     
individual health insurance coverage1   
health care professionals1 and health   
information technology software vendors4
  7#c7 ,application ,notwithstanding any
 other provision of law1 for purposes of
 this section1 the ,secretary may       
require the use of standards adopted    
under paragraph 7#b7 in lieu of any     
other applicable standards for an       
electronic transmission described in    
subsection 7a7 for prescription drugs   
for a participant1 beneficiary1 or      
enrollee described in such subsection4  
4  7b7 ,,erisa  7#a7 ,in general        
,subpart ,b of part #g of subtitle ,b of
 title ,i of the ,employee ,retirement  
,income ,security ,act of #aigd 7#bi    

,u4,s4,c4 #aahe et seq47 is amended by  
adding at the end the following3  #gbf4 
,electronic prior authorization for     
prescription drugs  7a7 ,in general ,for
 plan years beginning on or after       
,january #a1 #bjbg1 a group health plan 
or health insurance issuer offering     
group health insurance coverage shall   
provide for the secure electronic       
transmission of-- 7#a7 a prior          
authorization request from the          
prescribing health care professional for
 coverage of a prescription drug for a  
participant or beneficiary in such plan 
or coverage to such plan or issuer2 and 
7#b7 a response1 in accordance with this
 section1 from such plan or issuer to   
such professional4  7b7 ,electronic     
transmission  7#a7 ,exclusions ,for     
purposes of this section1 a facsimile1 a
 proprietary payer portal that does not 
meet standards specified by the         
,secretary1 or an electronic form shall 
not be treated as an electronic         
transmission described in subsection    

7a74  7#b7 ,standards ,in order to be   
treated1 for purposes of this section1  
as an electronic transmission described 
in subsection 7a71 such transmission    
shall comply with technical standards   
adopted by the ,secretary1 in           
consultation with the ,secretary of     
,health and ,human ,services1 the       
,secretary of the ,treasury1 the        
,national ,council for ,prescription    
,drug ,programs1 other standard-setting 
organizations as determined appropriate 
by the ,secretary1 and stakeholders1    
including group health plans and health 
insurance issuers offering group health 
insurance coverage1 health care         
professionals1 and health information   
technology software vendors4  7#c7      
,application ,notwithstanding any other 
provision of law1 for purposes of this  
section1 the ,secretary may require the 
use of standards adopted under paragraph
 7#b7 in lieu of any other applicable   
standards for an electronic transmission
 described in subsection 7a7 for        

prescription drugs for a participant or 
beneficiary described in such           
subsection4  4  7#b7 ,clerical amendment
 ,the table of contents in section #a of
 the ,employee ,retirement ,income      
,security ,act of #aigd 7#bi ,u4,s4,c4  
#ajja et seq47 is amended by inserting  
after the item relating to section #gbe 
the following3  ,sec4 #gbf4 ,electronic 
prior authorization for prescription    
drugs4  4  7c7 ,,irc  7#a7 ,in general  
,subchapter ,b of chapter #ajj of the   
,internal ,revenue ,code of #aihf is    
amended by adding at the end the        
following3  #ihbf4 ,electronic prior    
authorization for prescription drugs    
7a7 ,in general ,for plan years         
beginning on or after ,january #a1      
#bjbg1 a group health plan shall provide
 for the secure electronic transmission 
of-- 7#a7 a prior authorization request 
from the prescribing health care        
professional for coverage of a          
prescription drug for a participant or  
beneficiary in such plan to such plan2  

and  7#b7 a response1 in accordance with
 this section1 from such plan to such   
professional4  7b7 ,electronic          
transmission  7#a7 ,exclusions ,for     
purposes of this section1 a facsimile1 a
 proprietary payer portal that does not 
meet standards specified by the         
,secretary1 or an electronic form shall 
not be treated as an electronic         
transmission described in subsection    
7a74  7#b7 ,standards ,in order to be   
treated1 for purposes of this section1  
as an electronic transmission described 
in subsection 7a71 such transmission    
shall comply with technical standards   
adopted by the ,secretary of ,health and
 ,human ,services1 in consultation with 
the ,secretary of ,labor1 the ,national 
,council for ,prescription ,drug        
,programs1 other standard-setting       
organizations as determined appropriate 
by the ,secretary1 and stakeholders1    
including group health plans1 health    
care professionals1 and health          
information technology software vendors4

  7#c7 ,application ,notwithstanding any
 other provision of law1 for purposes of
 this section1 the ,secretary may       
require the use of standards adopted    
under paragraph 7#b7 in lieu of any     
other applicable standards for an       
electronic transmission described in    
subsection 7a7 for prescription drugs   
for a participant or beneficiary        
described in such subsection4  4  7#b7  
,clerical amendment ,the table of       
sections for subchapter ,b of chapter   
#ajj of the ,internal ,revenue ,code of 
#aihf is amended by adding at the end   
the following new item3  ,sec4 #ihbf4   
,electronic prior authorization for     
prescription drugs4  4