Medicine’s big win on prior authorization

In a big win for physicians and patients, the Centers for Medicare & Medicaid Services recently released a final prior authorization and interoperability rule  that makes significant improvements to the prior authorization process — most importantly, shortening the timeframes for payors to make decisions on such requests. Set to take effect in 2026, these changes apply only to government-regulated health plans. However, the FMA and other physician advocacy organizations are hopeful that this will increase the pressure on private payors to make meaningful authorization reforms as well.