The Association for Clinical Oncology (ASCO) submitted formal comments (see https://bit.ly/4xYRg1j) to the Centers for Medicare & Medicaid Services (CMS) in response to the 2026 CMS Interoperability Standards and Prior Authorization for Drugs proposed rule. If finalized, this rule will require Medicaid, Children’s Health Insurance Program, Medicare Advantage, and Marketplace plans to implement a streamlined electronic prior authorization process for all drugs beginning on October 1, 2027.
ASCO commends the agency for its efforts to streamline the prior authorization process, which remains a significant administrative burden that can delay patient access to life-saving cancer treatments. While the Association generally supports the proposal, its comments emphasize the need for stricter accountability, granular data reporting, and solutions for cross-facility care coordination.
Several critical areas for improvement to ensure that prior authorization does not restrict or delay patient access to cancer care include:
Electronic Prior Authorization for Prescription Drugs: ASCO strongly supports the proposal to require impacted payers to incorporate coverage and documentation requirements into a Prior Authorization Application Programming Interface by October 1, 2027.
Clearer Denials: ASCO supports the requirement for payers to provide specific, actionable reasons for any drug prior authorization denial, to help providers understand exactly what is needed for a successful appeal or resubmission.
Accelerated Decision Timeframes: ASCO supports reduced prior authorization decision time frames of 72 hours for standard requests and 24 hours for urgent requests, while also urging CMS to move toward true, real-time decision-making.
Accountability for Payers: ASCO maintains that if a physician does not receive a prior authorization decision within the required timeframe, the request should be considered approved and reimbursed by default to ensure patient care is not stalled.
Granular Transparency Metrics: ASCO urges CMS to require payers to report granular prior authorization at the specialty level—specifically for oncology—to allow for meaningful monitoring of how payer policies impact cancer treatment outcomes and patient access to care.
Addressing Multi-EHR Barriers: ASCO also highlights the operational difficulties providers face when patient documentation is split across multiple electronic health records. CMS must account for these technical barriers before penalizing clinicians under the Merit-based Incentive Payment System for failing to meet interoperability measures.
ASCO remains committed to advocating for policies that reduce administrative burden and prioritize the timely delivery of evidence-based cancer care.
