CMS proposes major changes to drug prior authorization processes

CMS published a proposed rule to establish new electronic prior authorization (ePA) standards specifically for drugs under Medicare Advantage, Medicaid, CHIP, and Exchange plans. The rule mandates the use of HL7 Fast Healthcare Interoperability Resources (FHIR) standards for near real-time data exchange. It targets reducing delays and increasing transparency for drug requests. The comment period is open; billing and clinical teams should monitor CMS-XXXX-XXXX for the final rule, which could reshape pharmacy benefit manager (PBM) interactions and require updates to practice management system integrations.