CMS Proposes Online Option for Part D Prior Authorization

Kerry Dooley Young

June 18, 2019

Clinicians may get an easier online path for completing Medicare Part D prior authorizations, as federal officials seek to update a burdensome process long handled by faxes and telephone calls.

The Centers for Medicare & Medicaid Services (CMS) yesterday announced a proposed rule that it said would ease the administrative hassle associated with Part D prescriptions. The aim is for clinicians to have an electronic option to satisfy the terms of prior authorization requirements in real time and before a prescription is transmitted to a pharmacy, CMS said.

CMS said this approach also would prevent cases of people enrolled in Part D plans arriving at pharmacy counters only to find their prescriptions cannot be filled due to prior authorization issues.

"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," CMS Administrator Seema Verma said in a statement.

Under the proposal, the insurers who run Medicare Part D plans would support version 2017071 of the National Council for Prescription Drug Programs (NCPDP) SCRIPT standard for electronic prior authorizations. Clinicians would then use that standard for handling electronic prior authorization, as needed, for patients enrolled in Medicare Part D.

CMS will accept comments on the proposal beginning June 19 through August 16, 2019. It intends to have the new rule take effect in January 2021. Still, the agency signaled the potential for delay with implementation of this electronic prior authorization process (ePA). In the proposed rule, CMS said it is seeking comments about whether there could be hurdles for Part D plans that would make the 2021 target date unfeasible.

"We also seek comment on strategies to mitigate burden in order to support successful adoption of this policy," CMS said. "Finally, we seek comment on any additional ways CMS can support plans as they transition to the ePA standard by the 2021 deadline."

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