AHA provides recommendations to CMS on proposed rule for interoperability standards and prior authorization for drugs

The AHA provided comments June 15 to the Centers for Medicare & Medicaid Services on its proposed rule establishing electronic standards for drug prior authorizations. The rule, issued April 10, proposes that payers support application programming interface-driven electronic prior authorization for drugs, make decisions on requests within shortened timeframes, and increase transparency for drug prior authorizations. The AHA called the rule “both timely and necessary,” creating an opportunity to simplify prior authorization processes. The AHA urged CMS and other agencies to adopt updates to support timely and consistent prior authorization decisions across all services, strengthen measures to improve the transparency and usability of prior authorization metrics, create a centralized and standardized repository of payer application programming interface endpoints, and advance a deliberate transition from X12 to Fast Healthcare Interoperability Resources-based prior authorization, among other recommendations.