H.R. 639 — Doctor Knows Best Act of 2025

This section prohibits group health plans and health insurance issuers offering group or individual health insurance coverage from imposing prior authorization requirements, utilization management techniques (including step therapy or fail-first protocols), or medical necessity reviews on any item or service for which benefits are available under the plan or coverage, effective for plan years beginning on or after January 1, 2026. The section further prohibits Federal health care programs (as defined in SSA §1128B(b)), including Medicare and Medicaid, and the Federal Employees Health Benefits (FEHB) program (chapter 89 of title 5, U.S. Code), along with states or other entities carrying out such programs, from imposing the same requirements beginning January 1, 2026. (Thus, all such plans and programs must provide benefits without pre-approval, step therapy, fail-first protocols, or medical necessity determinations.)