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Panel backs bill to eliminate prior authorization for many rare‑disease drug uses in commercial plans
Summary
Senators voted unanimously to recommend Senate Bill 39, a governor-backed measure that would remove prior authorization requirements for on‑ and off‑label use of FDA‑approved drugs for rare diseases in the commercial insurance market, and leave existing appeal routes through the Office of the Superintendent of Insurance in place.
The Senate Health and Public Affairs Committee gave Senate Bill 39 a due-pass recommendation, 9–0, moving the governor’s sponsored measure to the next step in the legislative process.
Sponsor Senator Stefanik said the bill removes prior-authorization barriers for people with rare diseases and expands earlier reforms to step therapy that the Legislature passed in prior sessions. She described rare diseases using the National Institutes of Health benchmark (fewer than 200,000 people nationwide) and said the bill covers both on-label and off-label use of FDA-approved medications when prescribed by an authorized clinician.
Debbie Armstrong, testifying by Zoom as an expert and patient, described her own diagnosis with a rare necrotizing myopathy and said delays from prior-authorization denials left her functionally impaired while she fought for coverage. “By the time I managed to fight the denials and get approval for treatment, I was almost completely dependent,” she told the committee.
Vyara Nakeva from the Office of the Superintendent of Insurance (OSI) said the bill is limited to the commercial market (OSI’s jurisdiction) and does not apply to Medicare or Medicaid plans, which are governed separately. OSI staff noted an appeal procedure would remain available: when an insurer denies a drug, the provider and patient may appeal to OSI’s peer-review process.
Pharmacy and payer groups raised concerns during testimony about patient safety, fiscal impacts, and implementation details for off‑label drug use. Jonathan Buxton of the Pharmaceutical Care Management Association told the committee the industry wanted to work with sponsors on language to ensure safe, implementable standards and to understand fiscal consequences.
Committee members asked how the bill interacts with federal Medicare/Medicaid rules and whether it would create implementation challenges; witnesses said the bill targets the private commercial market and that CMS rules for Medicare/Medicaid remain in place.
The committee approved a due-pass recommendation by roll call; senators voting in favor noted the bill’s focus on a small population with urgent clinical needs and emphasized existing appeal safeguards through OSI. The measure was referred as scheduled.
