CMS Proposes New Electronic Prior Authorization Process to Speed Access to Care

June 25, 2019

The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule to update and streamline the prior authorization process under Medicare Part D. The proposal aims to improve access to prescription medications for Part D beneficiaries and alleviate administrative burden for providers. Under the proposal, clinicians would be able to complete prior authorizations for Part D prescriptions online and through a more streamlined process. ASCO supports efforts to improve the prior authorization process for patients and providers, including electronic prior authorizations.

The proposal, if finalized, would 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, the rule would require all Medicare Part D plans to support the electronic prior authorization transaction standards developed by the National Council for Prescription Drug Plans (NCPDP). Additionally, clinicians who select the electronic option would typically be able to satisfy the terms of a prior authorization in real time and before a prescription is transmitted to a pharmacy.

ASCO supports efforts to streamline prior authorization and to improve Medicare beneficiary access to cancer drug treatments. The society applauds CMS efforts to improve patient access to prescription drugs by reducing the time it takes for a patient to receive needed medications, and ASCO appreciates the agency’s focus on alleviating administrative burden for providers.

Read the proposed rule.

ASCO will submit detailed comments on the proposal to CMS during the open comment period. For updates on this issue and breaking cancer policy news, visit ASCO in Action.