Advocacy & Practice Updates — Advocacy & Practice
ASRS Supports CMS E-Prior Authorization Proposals for Drugs but Recommends Further Administrative Burden Reductions
ASRS submitted comments to CMS last week on a proposed rule that would extend existing electronic prior authorization and interoperability standards to all drugs, including Part B Drugs, for Medicare Advantage. ASRS issued strong support for these proposals, noting that we recommended they be required for drugs as well when CMS initially instituted the standards for non-drug items and services in 2024. Beginning in 2027, the proposal would require plans to make information among payers and between payers and providers exchangeable in standardized format to request prior authorization, inquire about individual plan authorization requirements, and patients’ existing prior authorizations.
ASRS believes these proposals, should they be finalized, will help reduce patient wait time for treatment and administrative burdens on practices. However, we continued to encourage CMS to seek ways to speed up the prior authorization process or require plans to discontinue its use altogether. We cited data showing that while almost all retina specialists’ prior authorization requests are approved, plans continue to require them and routinely ignore what existing guardrails there are, including not honoring authorizations approved by another payer when a patient switches plans or moves, or requiring them to re-start step therapy. In addition, ASRS recommended that prior authorization or step therapy not be required in the fellow eye after successful approvals in the first. We encouraged CMS to enforce both existing and proposed regulations vigorously.
We will notify members when the final rule is released.
(Published 6.9.26)