CMS proposes prior authorization updates for Medicare Part D

June 20, 2019

The proposed rule would update the Part D e-prescribing program by adopting standards that ensure secure transmissions so as to expedite prior authorizations.

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would improve Medicare patients’ access to needed medications by updating the prior authorization process for Medicare Part D. The proposed rule would update the Part D e-prescribing program by adopting standards that ensure secure transmissions so as to expedite prior authorizations.

“This proposed rule would reduce the time it takes for a patient to receive needed medications and ease the prescriber burden by giving clinicians the flexibility and choice to complete prior authorization transactions electronically,” Seema Verma, CMS administrator, said in a press release.

The rule would allow physicians to submit prior authorization requests online. Doctors choosing this option will typically be able to satisfy the terms of a prior authorization in real time and before a prescription is transmitted to a pharmacy. This would eliminate patients finding out at the pharmacy counter that their prescription cannot be filled.

The proposed rule would also implement new prior authorization transaction standards for the Part D e-prescribing program as required by the SUPPORT for Patients and Communities Act. The proposed standards would begin in January 2021. If finalized, all Medicare Part D plans would be required to support electronic prior authorization transaction standards that were developed by the National Council for Prescription Drug Plans.

Comments to the proposed rule are due no later than 5 p.m., Aug. 16, 2019.

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