CMS proposes electronic prior authorization and faster decisions for drugs
On April 10, 2026, CMS proposed a rule (CMS-0062-P) that extends its 2024 electronic prior authorization requirements to drugs. It would apply to Medicare Advantage plans, Medicaid and CHIP, and ACA exchange plans, and it adds small-group exchange insurers. Payers would need FHIR-based prior authorization APIs for drugs. ACA exchange plans would have to decide within 72 hours for standard requests and 24 hours for expedited ones, and Medicaid within 24 hours. Payers would also have to give a specific reason for every drug prior authorization denial. Most provisions would take effect October 1, 2027, and comments were due June 15, 2026.
Why it's notable: The 2024 rule left drugs out, and drug prior authorization is one of the biggest paperwork burdens in clinics. This proposal would bring it under the same electronic process, deadlines and denial-reason rules.