Medicare and Medicaid reforms could reshape care for millions

CMS proposed requiring insurers to decide urgent drug prior authorizations within 24 hours and standard requests within 72 hours, and to expand electronic prior authorization systems across federal programs.

Long delays tied to insurance approval are being highlighted as a major barrier to prescribed treatment. CMS has proposed a rule that would set faster deadlines for drug prior authorizations and push for electronic systems and greater transparency. Officials framed the changes as modernization intended to reduce administrative friction and speed access to medications. The proposal would apply across multiple federal programs and will go through a public comment period before any final rule is issued. Key details: - The proposal would require insurers to decide urgent drug prior authorization requests within 24 hours and standard requests within 72 hours. - It would extend electronic prior authorization requirements to prescription drugs for the first time, aiming to replace fax-based and fragmented workflows. - If finalized, requirements would apply broadly across Medicare Advantage, Medicaid, the Children’s Health Insurance Program (CHIP), and plans sold through Affordable Care Act marketplaces, and would include small group plans on federal exchanges. - Plans would have to publicly report detailed prior authorization data for prescription drugs, including approval and denial rates, appeal outcomes, and decision timelines. - CMS is proposing adoption of newer data standards to enable real-time electronic submissions and faster sharing of clinical information. - CMS said most compliance dates would begin in 2027, and the proposal will be subject to a public comment period before any final rule is issued. Summary: The proposed rule aims to shorten approval timelines, expand electronic drug authorization, and increase transparency across major public programs. Research cited in the proposal notes prior authorization delays have been associated with worsened clinical outcomes in several specialties. The next formal step is a public comment period; the rule could be revised before finalization and most compliance dates are planned to start in 2027.