CMS Releases Proposed Rule To Establish Deadlines For Payers To Issue Prior Authorization For Drugs

The Centers for Medicare & Medicaid Services released a proposed rule to “slash long waiting periods for drugs.” The Interoperability Standards and Prior Authorization for Drugs proposed rule would establish clear decision deadlines for payers to issue a prior authorization decision for drugs. Payers would be required to issue prior authorization decisions for drugs no later than 24 hours for urgent requests and 72 hours for standard requests. The rule also would increase transparency through requiring full disclosure of claims denials and appeals outcomes.

In addition, CMS is seeking comments on ways to streamline the step therapy process using technology and data sharing, such as the Payer-to-Payer API. Comments are due 60 days after the date of publication in the Federal Register. MHA will soon publish an issue brief with additional details.