What does Preamble of Access to Innovative Treatments Act of 2026 do?

This bill aims to amend title XVIII of the Social Security Act. The proposed amendment concerns a review process for adverse national coverage determinations. The review process specifically relates to drug coverage under the Medicare program.

What does SHORT TITLE. of Access to Innovative Treatments Act of 2026 do?

This bill is formally titled the Access to Innovative Treatments Act of 2026.

What does PROVIDING A REVIEW PROCESS FOR ADVERSE NATIONAL COVERAGE of Access to Innovative Treatments Act of 2026 do?

This section amends Section 1862(l) of the Social Security Act to establish a review process for adverse national coverage determinations (NCDs) for drugs and biologicals. The Secretary must initiate a review within 90 days of receiving a request and provide a 30-day public comment period. The Secretary must make a final decision within 120 days of the public comment period, including summaries of comments and responses. If the Secretary reverses or modifies an NCD, they must assign a temporary or permanent code and implement the change. Successive reviews of the same NCD are limited to once every two years, unless the Secretary deems further review appropriate. A 'specified national coverage determination' is defined as one made for a drug or biological approved under specific federal acts where coverage was denied or limited inconsistently with the approval or licensure. The Secretary may not apply pre-existing NCDs to newly approved drugs or biologicals if it would deny or limit coverage inconsistently with the approval or licensure. Section 1860D-2(e)(3) of the Social Security Act is amended to prevent prescription drug plans and MA-PD plans from basing coverage determinations on specified NCDs.

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Access to Innovative Treatments Act of 2026

Last updated: 6/24/2026 · Introduced: 6/24/2026

Author: Nanette Barragán (D-CA)

TL;DR (AI)

This bill establishes a formal review process for Medicare's national coverage determinations (NCDs) concerning drugs and biologicals, requiring the Secretary to act within specific timeframes and consider public comments.
The bill prevents Medicare from applying pre-existing NCDs to newly approved drugs or biologicals in a way that contradicts federal approval or licensure.
Prescription drug plans and Medicare Advantage plans with prescription drug coverage are prohibited from using specified NCDs as the basis for coverage decisions.

119th Congressin committeeOfficial page

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Other Sections

Includes provisions on preamble, short title., and 1 more.

3 sections

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