CMS Proposes Drug Prior Authorization Overhaul, Aims for 72-Hour Decision Timeframes

CMS issued a proposed rule to streamline prior authorization for Part D and MA drugs, mandating payer response decisions within 72 hours for urgent requests and 7 days for standard ones. It would require payers to build and maintain a 'Patient Access API' to share PA data and decisions programmatically. The rule targets a leading cause of prescription abandonment and delayed therapy starts. The comment period closes June 13, 2026. Monitor for the final rule's interoperability and timeline requirements, which would reshape pharmacy benefit workflows.