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Committee approves bill to exempt some rare‑disease uses from prior authorization reviews
Summary
Senate Bill 39 would prevent insurers and state plans from requiring prior authorization or step therapy for FDA‑approved drugs when used off‑label to treat rare diseases; sponsor and an expert patient testified about delays that occur when treatments lack specific FDA labeling.
The committee voted to pass Senate Bill 39 as amended, a bill intended to shorten or eliminate prior‑authorization hurdles for patients with rare diseases when FDA‑approved drugs are prescribed off‑label as standard clinical practice.
Representative Debbie Armstrong, presenting as an expert witness and identifying the measure as a governor’s bill, described her own experience with a rare autoimmune disease and the prolonged appeals she faced to obtain an accepted off‑label treatment. Armstrong said the bill clarifies that rare diseases — defined consistent with federal law — qualify for exemptions from step therapy and prior authorization that otherwise cause harmful delays. "Just think of those who don't," Armstrong said, urging the committee to consider patients who lack the knowledge or access to navigate repeated denials.
Jonathan Buxton of the Pharmaceutical Care Management Association said the association opposed the bill in its current draft and asked for administrative amendments to ensure workable timelines and protections already in place for prior authorization processes.
Committee members asked whether the bill would change reimbursement rules for Medicare/Medicaid populations. Sponsors clarified that the bill changes prior‑authorization procedures and medical‑necessity determinations rather than reimbursement mandates; Medicaid match rules were discussed but not altered in the bill language itself. Supporters said the change is a process reform to let clinicians access FDA‑approved drugs for rare conditions without extended appeals when standard clinical practice supports that use.
After committee questions and brief comments, Speaker Martinez moved a do‑pass motion; the committee recorded a do pass on SB 39 as amended. The sponsor and witnesses said the bill is intended to reduce delay and administrative burden for patients with rare diseases while preserving clinical‑practice and reimbursement frameworks.
