The Centers for Medicare & Medicaid Services (CMS) issued a final rule that requires Part D prescription drug plans support a new electronic prior authorization transaction standard for their Part D e-prescribing programs. This new electronic prior authorization standard will allow prescribers to see that a drug is subject to prior authorization, while they are prescribing it. This policy change helps ensure that there are secure electronic transactions between prescribers and Part D plan sponsors, and that patients will not experience delays when picking up their prescriptions. CMS will begin enforcing the requirements of this rule on January 1, 2022, although Part D sponsors may choose to implement the new transaction standard earlier. This action is part of CMS’s commitment to strengthen Medicare, ensure safety and quality, and put patients over paperwork.
This final rule requires that Part D plans adopt the electronic prior authorization standard called the National Council for Prescription Drug Programs (NCPDP) SCRIPT standard version 2017071, which ensures secure transmissions and expedites prior authorizations by requiring providers to electronically supply clinical information, such as a patient’s diagnosis, before the prescription is sent to the pharmacy. Through this new process, beneficiaries can receive their medication faster, by decreasing the amount of time it takes to process prior authorizations. This rule also implements the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act requirement for the adoption of the electronic prior authorization standard for the Part D e-prescribing program.
With this new electronic prior authorization standard, prescribers would be able to choose to initiate and manage the process for Part D drug approvals within their electronic prescribing system, improving the process without requiring that patients take any additional steps to complete the prior authorization.
The final rule (CMS-4189-F) can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/2020-28877/medicare-program-secure-electronic-prior-authorization-for-medicare-part-d