What You Should Know:
– The U.S. Department of Health and Human Services (HHS) has announced a new regulatory reform that will give doctors and patients real-time access to prescription drug information.
– The rule, which takes effect on October 1, will allow millions of Americans for the first time to compare drug prices, view out-of-pocket costs, and access prior authorization requirements. The reform aims to help them identify the most cost-effective treatments and prevent health insurers from blocking physician-approved care.
– The regulatory reform follows a June 2025 roundtable meeting between Secretary of Health and Human Services Robert F. Kennedy, Jr., CMS Administrator Dr. Mehmet Oz, and major health insurers covering nearly eight in ten Americans. At the meeting, health insurers pledged six key reforms to cut red tape, accelerate care decisions, and enhance transparency for patients and providers.
Expanding Interoperability and Reducing Administrative Burden
The HHS final rule, which was finalized through the HHS Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), ensures that healthcare providers using certified health IT systems can submit prior authorizations electronically. It also allows providers to select drugs consistent with a patient’s insurance coverage and exchange electronic prescription information with pharmacies and insurance plans. The new rule complements policies from the Centers for Medicare & Medicaid Services (CMS) and expands interoperability to ease administrative burdens.
According to HHS Secretary Kennedy, the rule is a decisive step to “overhaul our nation’s broken prior authorization system”. He stated that by improving patient outcomes, cutting provider burden, and ensuring transparency at the point of care, HHS is delivering on its promise to “Make America Healthy Again”. CMS Administrator Dr. Mehmet Oz added that this is about making care “simpler, fairer, and more affordable” by reducing red tape and providing faster answers.
New Policies Benefits
The complementary policies from CMS and ASTP/ONC will have several key benefits:
- Accelerate Electronic Prior Authorization: Providers will be able to electronically submit prior authorizations using ASTP/ONC certified health IT. This will result in faster care authorization decisions and more transparency for patients and providers.
- Improve Drug Cost Transparency: Health IT tools certified by ASTP/ONC will enable prescribers to compare drug prices in real time and identify lower-cost alternatives available under a patient’s insurance coverage. This is particularly beneficial for patients covered under Medicare Part D.
- Reduce Burden: Improvements in workflow automation and more timely, transparent decision-making have the potential to save millions of hours of clinician time and billions of dollars in labor costs. This will ensure that clinicians can spend more time with patients and less time on paperwork.
