US HB2433

Requires all prior authorization decisions and adverse determinations under Medicare, Medicare Advantage, and prescription drug plans to be made by board-certified physicians in the same specialty as the treating provider

Mandates that coverage restrictions be based solely on medical necessity and written clinical criteria that are evidence-based, reflect community standards, and updated annually

Prohibits denial of coverage for health care services solely because no evidence-based standard exists for that particular service

Requires contractors and plans to post all preauthorization requirements and clinical criteria on public websites, and provide 60 days written notice before implementing new or amended requirements

Applies to contracts entered into 90 days or more after enactment, covering Medicare administrative contractors, Medicare Advantage organizations, and prescription drug plan sponsors