CMS and prior authorization

Last month, the Centers for Medicare & Medicaid Services proposed new requirements for the prior authorization of drugs for patients served by Medicare Advantage, Medicaid, CHIP, and qualified health plans in the federal marketplace. This proposal represented a next step to requirements CMS laid out in 2024 when it called on payers to offer electronic prior authorization for medical services and to respond to providers within required timeframes:  seven days for standard requests and 72 hours for expedited requests. Now, CMS proposes requiring these payers to meet these standards through electronic prior authorization for drugs covered under their plans’ pharmacy [...]