CMS proposes rule to standardize, speed up drug prior authorization

CMS published a proposed rule to establish national interoperability and prior authorization standards for drugs covered by Medicare Advantage, Medicaid, CHIP, and Qualified Health Plans. The rule mandates payers build APIs to provide real-time patient coverage and benefit data, respond to prior authorization requests for drugs within 72 hours for standard requests and 24 hours for urgent cases, and publicly report metrics on approval and denial rates. The 60-day comment period closes in mid-June 2026. Monitor the CMS docket (CMS-2026-XXXX) for the final rule, which would force payer portals to modernize and could reduce follow-up calls on drug coverage.