Advocacy & Practice Updates — Advocacy & Practice
CMS Excludes Drugs From Electronic Prior Authorization Rule Over ASRS Objections
Yesterday, CMS released a final rule that requires Medicare Advantage (MA) plans to adopt standards to facilitate electronic prior authorizations. The final rule aims to speed up the prior authorization process to ensure patients’ access to timely care. Disappointingly, CMS chose to exclude all drugs—including Part B drugs paid through a medical benefit (such as anti-VEGF)—from this requirement.
ASRS strongly opposed this in our comments on the proposed rule and joined in letters from the Alliance of Specialty Medicine and the AMA recommending that drugs be included in the final rule. CMS notes in the final rule that it did not anticipate the overwhelming response it received in favor of including drugs, and so it will evaluate options for potentially including them in the future. ASRS and our coalition partners will continue to advocate for the inclusion of drugs, potentially through legislative efforts.
CMS, however, did finalize many ASRS-supported provisions in this rule including providing patients with electronic access to prior authorization information and decreasing the time limit for an insurer to respond to a prior authorization request.
ASRS strongly opposed this in our comments on the proposed rule and joined in letters from the Alliance of Specialty Medicine and the AMA recommending that drugs be included in the final rule. CMS notes in the final rule that it did not anticipate the overwhelming response it received in favor of including drugs, and so it will evaluate options for potentially including them in the future. ASRS and our coalition partners will continue to advocate for the inclusion of drugs, potentially through legislative efforts.
CMS, however, did finalize many ASRS-supported provisions in this rule including providing patients with electronic access to prior authorization information and decreasing the time limit for an insurer to respond to a prior authorization request.
(Published 1.17.24)