CMS details proposed rule to standardize electronic drug prior authorization

CMS published its proposed rule on interoperability and prior authorization for drugs in the Federal Register on April 14. The rule would require Medicare Advantage, Medicaid managed care, and Marketplace plans to implement a standard electronic PA process for Part D drugs. This builds on existing CMS regulations for medical services. The 60-day comment period closes June 13, 2026. Billing teams should track this rule's finalization, as it will mandate specific data exchange standards and could reduce manual follow-up for pharmacy benefit authorizations.