CMS e-Prescribing Update Would Allow Physicians to Complete Prior Authorizations Online

The Centers for Medicare and Medicaid Services (CMS) today proposed a rule to improve access to medications by updating the prior authorization process for Medicare Part D to give clinicians the option to complete prior authorizations online.

The proposed rule offers a new transaction standard for the Medicare Prescription Drug Benefits program’s electronic-prescribing (e-prescribing) program required by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. Under the SUPPORT Act, the secretary of the U.S. Department of Health and Human Services is required to adopt standards for Part D e-prescribing to ensure secure electronic prior authorization request and response transmissions.

Through the proposed rule, clinicians would complete prior authorizations online, which could create a more streamlined process for performing prior authorization for Part D prescriptions. Administrative tasks are linked to physician burnout, and this rule has the potential to help reduce that burden.

Clinicians who complete prior authorizations electronically could be able to satisfy the terms of a prior authorization in real time and before a prescription is transmitted to a pharmacy.

“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,” said CMS Administrator Seema Verma, MPH.

As it stands now, prior authorization requires providers to supply extra clinical information to verify that the medication can be covered under the Part D benefit. The process promotes better clinical decision-making and ensures patients receive necessary prescriptions.

The proposed rule would begin January 2021. If it’s finalized, all Part D plans would be required to support electronic prior authorization transaction standards developed by the National Council for Prescription Drug Plans.

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