CMS Proposes Updates to Electronic Prescribing Standards

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule aimed at providing patients better access to needed medications and reducing administrative burden by revising the prior authorization process for Medicare Part D, specifically regarding the electronic prescribing program.

The prior authorization process currently in place requires additional provider-supplied clinical data for further verification that Medicare Part D covers a patients’ needed medication. In turn, the process helps promote better clinical decision making and ensures patients are receiving the correct and most effective treatment.

“Improving patients’ access to prescription drugs is a top priority for CMS,” said CMS Administrator Seema Verma in a press release. “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.”

Per the proposed rule and associated press release, “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.”

Further, “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.”

According to the press release, the proposed rule would enact new prior authorization transaction standards for the Part D e-prescribing program as required by the SUPPORT for Patients and Communities Act.

CMS is accepting comments through August 16 and the new 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,” stated CMS a press release.—Edan Stanley