On April 10, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to establish electronic standards for prescription drug prior authorizations and require timely responses from insurers. Implementation is set for October 2027.
Prior authorization requires health care providers to obtain approval from a patient’s insurance provider before prescribing medications or providing a medical service. A 2024 final rule established standards for medical procedures but did not include prescription drugs. The new proposed rule fixes this gap by setting a 24-hour deadline for Medicaid insurers to respond to medication requests.
The National Health Care for the Homeless Council strongly supports this proposed rule because it will increase access to care, save many hours of work for providers, and improve health care outcomes for patients. The Council evaluates policies based on their impact on patient care, and this proposal represents a meaningful step forward.
Too often, vulnerable people—and their providers—must wait days (sometimes weeks) for an insurance company to approve care. For urgent conditions, those delays can mean worsening illnesses or missed opportunities for treatment. Because people die when they cannot get the medications they need, it is not an overstatement to say this change will save lives.
We strongly support this new rule and look forward to Health Care for the Homeless providers being able to deliver more timely, effective care to patients without homes.
###
