The Centers for Medicare & Medicaid Services (CMS) has issued the 2026 CMS Interoperability Standards and Prior Authorization for Drugs proposed rule. The proposal aims to shorten care delays and improve transparency within federal health insurance programs by establishing electronic prior authorization (ePA) requirements for covered prescription drugs and expedite federal response deadlines to ensure patients receive life-critical medications without administrative delay.
Beginning October 1, 2027, the proposed rule would require included plans to implement and maintain a Prior Authorization Application Programming Interface (API) to facilitate ePA for covered prescription drugs, aligning Prior Authorization API standards for prescription drugs with those for non-drug items and services, a change the Association for Clinical Oncology (ASCO) has advocated for previously. The proposal would also establish timeframes for prior authorization decisions of no longer than 24 hours for urgent requests and 72 hours for standard requests.
ASCO has long advocated for prior authorization reforms that address harms to patients. A survey of ASCO members found that nearly all participants report a patient has experienced harm because of prior authorization processes, including delays in treatment (96%), significant impacts on patient health such as disease progression (80%), and loss of life (36%).1
ASCO will also continue to advocate for policies that further reform prior authorization and improve patient access to cancer care.— Lynn M. Schuchter, MD, FASCO, 2025-2026 Chair of the Association Board
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A statement from Lynn M. Schuchter, MD, FASCO, 2025-2026 Chair of the Association Board follows:
“By requiring federal health plans to support electronic prior authorization for covered prescription drugs, and establishing clear timelines for prior authorization decisions, the proposed rule, if finalized, would mark an important step toward improving patient access to the care they need when they need it. This is especially important for people with cancer, for whom treatment delays may lead to worse outcomes.
ASCO appreciates that CMS responded to calls from the Association and other stakeholders about the need to include prescriptions drugs in prior authorization reforms. Prior authorizations for prescription drugs significantly contribute to the growing administrative burdens that divert clinicians from patient care and hinder access to treatment.
We look forward to submitting the cancer community’s perspective on this proposed rule during the comment period [June 2026]. ASCO will also continue to advocate for policies that further reform prior authorization and improve patient access to cancer care.”
Reference
1. A Proposed Rule by the Centers for Medicare & Medicaid Services.http://bit.ly/4g714ja Accessed June 8, 2026.
