“If finalized, the potential impact of the rule is likely to be significant:
- Patients: would benefit from faster decisions (24 hours for urgent and 72 hours for standard requests) designed to reduce waiting periods for critical medications.
- Providers: would gain more EHR-integrated workflows that reduce unnecessary or incomplete requests and administrative burden, letting them spend more time on patient care rather than paperwork.
- Payers: would face new operational requirements to implement electronic PA for all drugs, provide specific denial reasons, and meet strict decision timeframes.
- EHR vendors: would benefit from a centralized endpoint registry that reduces integration burden and improves API reliability by eliminating the current problem of hard-to-update endpoint information.
- The public: would gain access to publicly posted drug PA metrics beginning in 2028, allowing comparison of approval and denial rates, appeal outcomes, and decision times across plans and plan types.”