The Centers for Medicare & Medicaid Services (CMS) has released the 2026 CMS Interoperability Standards and Prior Authorization for Drugs proposed rule with the intent to improve prior authorization so patients and providers can benefit from a more expeditious, transparent and reliable process. Specifically, CMS proposes to require impacted payers to support electronic prior authorization, to make decisions on requests within shorter timeframes, and to increase transparency for the prior authorization of drugs. If finalized, this rule would take effect on Oct. 1, 2027.
This proposed rule also includes several requests for information, asking for public comment on addressing step therapy, prior authorization for laboratory tests and durable medical equipment, and data sharing in value-based care models, among other topics.
The public policy team will be drafting comments to respond to this proposed rule. For more information, you can read the CMS fact sheet or the rule on the Federal Register.