Advocacy & Practice Updates — Advocacy & Practice
CMS Proposes Requiring MA Plans to Implement Electronic Prior Authorization for Drugs
Late last week, CMS released a proposed rule, the 2026 Interoperability Standards and Prior Authorization for Drugs, that proposes to require Medicare Advantage (MA) plans implement electronic standards to facilitate prior authorization for drugs by October 1, 2027. The proposal includes drugs covered by both the medical and pharmacy benefits.
This proposal builds on an earlier rule finalized in 2024 that required plans to implement electronic prior authorization for non-drug services, such as procedures or imaging. While ASRS and others in the medical community supported the policy at the time, we questioned why drugs were excluded—particularly physician-administered drugs that were authorized through the same claims system as the other services. CMS acknowledged those questions and issued this proposed rule in response. In addition, MA plans, as well as state and managed Medicaid programs and some state Children’s Health Insurance Program (CHIP) plans, would now also be required to respond to urgent requests for drug authorizations within 24 hours and 72 hours for routine requests, and publish annual metrics on their use of prior authorization.
There is a 60-day comment period on the rule, but CMS did not indicate when it plans to issue a final rule. Additional information is available in a CMS fact sheet. We will keep you updated.
(Published 4.14.26)