The Centers for Medicare and Medicaid Services (CMS) has proposed significant steps to streamline and digitize prior authorizations for drugs.

In the 2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule published in the Federal Register on April 14, 2026, CMS proposed requirements for impacted payers to use electronic prior authorizations for drugs using FHIR-based APIs. Overall, CMS is encouraging a streamlined, interoperable workflow, quicker decision making, and increased transparency around the prior authorization process.

Proposed changes, to start taking effect in October 2027, include:

• Requiring impacted payers to use electronic prior authorization (ePA) processes for drugs, which expands requirements from the 2024 CMS Interoperability and Prior Authorization final rule
• Requiring use of FHIR-based APIs in ePA to support an interoperable, streamlined workflow
• Tightening turnaround times to respond to ePAs; and
• Requiring public reporting of ePA metrics to increase transparency and accountability

In addition, CMS has included four relevant requests for information around electronic event notifications, cybersecurity measures, API technology, and technology to support step therapy.

HIMSS has created a detailed fact sheet on the proposed rule and will be issuing comments before the CMS public comment deadline of June 15, 2026. If HIMSS members have feedback on the proposed rule, please send your comments to alana.lerer@himss.org.