CMS Seeks Comments on Proposed Updates to e-Prescribing Rule

PUBLISHED: Jun 27, 2019
Relevant to: All Healthcare Organizations

The U.S. Centers for Medicare and Medicaid Services (CMS) is seeking comment on their proposed rule designed to improve patients’ access to needed medications by updating the prior authorization process for Medicare Part D, which is the program that provides coverage for prescription drugs that beneficiaries pick up at a pharmacy counter. The prior authorization process requires that providers supply additional clinical information to verify that the medication can be covered under the Medicare Part D benefit.

The proposed rule would update the Part D e-prescribing program by adopting standards that ensure secure transmissions and expedite prior authorizations. Under the proposed change, clinicians would be able to choose to complete prior authorizations online, reducing burden for providers through a more streamlined process for performing prior authorization for Part D prescriptions. Clinicians who select the electronic 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 is so patients do not arrive at a pharmacy counter only to find that their prescription cannot be filled.

The proposed rule 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, 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 (NCPDP).

CMS is currently seeking comment on this proposed rule. Comments will be accepted through August 16, 2019.

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