Goodsurance

Policy & oversight

Drug approvals are going electronic

A proposed Medicare rule would move prior authorization for prescription drugs onto fast electronic systems by late 2027, aiming to shorten the wait that can hold up a medication.

By the Goodsurance editorial teamJune 30, 2026

Prior authorization is the step where your plan has to approve certain drugs or services before it will pay for them. Done by fax and phone, it can mean days of waiting at exactly the wrong moment. A Medicare proposal out this spring would push that process onto modern electronic systems for prescription drugs. On April 14, 2026, Medicare published a proposed rule, known as CMS-0062-P, that would require Medicare Advantage plans and other payers to handle prior authorization for drugs through standardized electronic connections, with the drug piece taking effect October 1, 2027. It builds on an earlier 2024 rule that already set firmer timelines for Advantage plans, standard decisions within seven calendar days and urgent ones within 72 hours, and required electronic prior authorization systems for non drug items and services starting in 2027. The new proposal extends that electronic approach to medications for the first time. Medicare estimates the broader prior authorization modernization could save roughly 15 billion dollars over ten years, mostly in reduced paperwork. For a patient, the promise is plainer: fewer faxes, faster answers, and more visibility into where a request stands. Two caveats keep this honest. First, it is a proposal whose public comment period has closed, not a final rule, and the drug provisions would not take effect until late 2027. Second, faster plumbing does not by itself change what a plan chooses to approve. The pointed debate over whether prior authorization is overused to deny care routes to my65checklist; here the useful job is to explain what prior authorization is and what this change would and would not do.

In plain words

Sometimes your plan must say yes before it will pay for a drug or a service. This step is called prior authorization. Today it often runs on faxes and phone calls. That can mean waiting for days. A new Medicare plan would move this online for drugs. On April 14, 2026, Medicare put out a proposed rule. It would make plans handle drug approvals through fast computer systems. The drug part would start October 1, 2027. An earlier rule already set time limits for Medicare Advantage plans. They must answer standard requests within seven days, and urgent ones within 72 hours. Medicare says going electronic could save about 15 billion dollars over ten years, mostly on paperwork. For you, the hope is simple: fewer faxes, faster answers, and a clearer view of where your request stands. Two things to remember. This is only a proposal for now, not a final rule, and the drug part would not start until late 2027. And faster systems do not change what a plan decides to cover.

Understand the basics first

Source: Centers for Medicare and Medicaid Services
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