Major Medicare, Medicaid Reforms Could Change Care For Millions
Summary
Federal health officials have proposed new rules to speed up approval times for prescription drugs under Medicare, Medicaid, and related health plans. The plan includes faster decision deadlines, more use of electronic systems, and new requirements for insurers to share approval data publicly.Key Facts
- The Centers for Medicare & Medicaid Services (CMS) wants insurers to decide urgent drug requests within 24 hours and standard requests within 72 hours.
- The proposal aims to reduce delays caused by prior authorization, which often slows down patient access to prescribed medications.
- It promotes moving from fax-based and manual approval methods to fully electronic systems for faster, real-time decisions.
- The new rules would apply to Medicare Advantage, Medicaid, the Children’s Health Insurance Program, and health plans sold through Affordable Care Act marketplaces.
- Insurers would have to report approval and denial rates, appeals, decision times, and their use of electronic prior authorization systems.
- CMS plans to replace outdated technical standards with newer ones to improve data sharing and approval speed.
- The reforms aim to standardize drug approval processes so patients have similar experiences across different government health programs.
- Health and Human Services Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz support these changes as ways to reduce administrative burdens and improve patient care.
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