DecisionHealth, DecisionHealth - 2026 Issue 5 (May)

Drug-related prior auth rule proposes tight deadlines, fast technology

A new proposed rule covering interoperability and prior authorization for drugs would, essentially, impose prior authorization requirements on payers in major federally funded health care programs for outpatient drugs. These proposed requirements are similar to those imposed by the 2024 final rule for non-drug items and services — except this rule is a tad more friendly to providers.

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