Policy & oversight
A Pending CMS Rule Would Set Hard Time Limits on Drug Prior Authorization Decisions in Medicare Advantage
CMS's proposed interoperability and drug prior authorization rule (CMS-0062-P) would require Medicare Advantage and other plans to resolve urgent drug requests within 24 hours and standard requests within 72 hours.
By the Goodsurance editorial teamSeptember 8, 2026
A proposed federal rule would, if finalized, set legally binding decision deadlines and extend electronic prior authorization requirements to prescription drugs in Medicare Advantage, Medicaid, and other federally regulated health plans. The rule, CMS-0062-P, was published in the Federal Register on April 14, 2026. The public comment period closed June 15, 2026, and a final rule is expected before year-end.
Under the proposal, impacted payers, including Medicare Advantage organizations, would be required to resolve urgent drug prior authorization requests within 24 hours and standard requests within 72 hours. Payers would also need to support electronic prior authorization for drugs using established pharmacy-industry standards, including National Council for Prescription Drug Programs standards for prescription transmission and real-time benefit information.
A pending CMS rule would cap drug prior authorization wait times at 24 hours for urgent cases and 72 hours for standard ones in Medicare Advantage.
The rule would additionally require payers to increase transparency by disclosing data on drug prior authorization decisions, denials, and appeals outcomes.
Medicare Part D sponsors are already required to support electronic prior authorization for drugs. CMS states the proposed rule would extend that foundation more broadly across programs.
If finalized on the proposed schedule, requirements for Medicare Advantage would take effect around October 2027. The rule would not apply to Original Medicare fee-for-service, which operates under a separate claims process.
For the roughly 35 million people in Medicare Advantage, binding time limits on drug approval decisions could reduce the delays that patients and physicians frequently encounter when managing ongoing or newly prescribed treatments.
In plain words
The government has proposed a new rule about how fast health plans must approve drug prescriptions. It covers Medicare Advantage plans and some other plans.
For urgent requests, plans would have to say yes or no within 24 hours. For regular requests, plans would have 72 hours to decide.
Plans would also have to use electronic systems to handle drug approvals. Right now, the process is often slow and involves phone calls or paper forms.
The government published this rule in April 2026. People had until June 15 to send comments. A final decision is expected before the end of 2026.
If the rule is approved, Medicare Advantage members would know exactly how long they should wait for a drug to be approved.
Understand the basics first
Source: CMS
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