CMS Proposes Major Changes to Drug Prior Authorization for MA, Medicaid, CHIP

CMS published a proposed rule on April 14, 2026, aiming to streamline prior authorization processes and advance interoperability for drugs covered by Medicare Advantage, Medicaid managed care, CHIP, and QHP plans. The rule targets standards for electronic PA requests and responses, requiring payers to implement specific APIs and adhere to standardized timelines. For practices, this signals a potential reduction in manual fax and phone-based PA workflows for medications, but the changes are not immediate. The comment period is open, with a final rule and implementation timeline expected later in 2026. Monitor CMS-2026-07205 for the final rule, which will dictate new submission requirements.