(April 16, 2026) - Last week, the Centers for Medicare & Medicaid Services issued a proposed rule that would require some insurers to accept electronic prior authorization for prescription drugs and make decisions on requests within shorter timeframes.
This proposal builds on a 2024 final rule that established prior authorization standards for medical services. The new prior authorization standards for drugs would require plans to make decisions within 24 hours for urgent cases and within 72 hours for standard cases.
The proposed requirements would apply to Medicare Advantage plans, the Children's Health Insurance Plan, Medicaid and insurers on the federally facilitated health exchanges. Payers also would be required to publicly report prior authorization approval and denial rates, appeal outcomes and decision time frames.