CMS proposes new standards for prior auth on Part D drugs

CMS issued a proposed rule to establish new interoperability and prior authorization standards for Medicare Advantage, Medicaid managed care, and CHIP plans, specifically targeting prescription drugs. The rule aims to standardize prior auth data exchange for Part D medications. The comment period closes in June 2026. If finalized, this could require practice EHRs and clearinghouses to support new API-based transaction flows for drug authorizations in 2027.