# Plain Language Summary: Doctor Knows Best Act of 2023

This bill would eliminate three common insurance practices that currently delay or block patients from getting medical treatments. Right now, when your doctor prescribes a medication or recommends a procedure, your insurance company can require "prior authorization"—meaning they review the treatment first and decide whether to approve it before you can receive it. Insurance companies also use "utilization management" techniques, which include "step therapy" (forcing you to try a cheaper drug first, even if your doctor thinks a different one is better) and "fail-first" protocols (requiring you to fail on one treatment before approving another). Additionally, insurers conduct "medical necessity reviews" to determine if they think a treatment is actually necessary. This bill would ban all three of these practices for both private insurance plans and federal health programs like Medicare and Medicaid.

The practical effect would be significant: if you get a prescription from your doctor or your doctor recommends a medical procedure, your insurance would have to cover it without requiring advance approval or making you jump through hoops first. You wouldn't have to wait days or weeks for insurance company approval before starting a medication your doctor prescribed. However, this also means insurance companies would lose one of their main tools for controlling costs and preventing unnecessary treatments. Supporters argue this puts doctors back in charge of medical decisions, while critics worry it could lead to higher insurance premiums and unnecessary spending on treatments that might not be medically appropriate. The bill would take effect on January 1, 2024, for private insurance and federal health programs.