The Trump Administration announces new changes to ease approval of treatments and inform patients up front of the most appropriate and lowest cost prescription drugs.
The U.S. Department of Health and Human Services (HHS) today announced a new rule that will provide unprecedented, real-time access to prescription drug information for doctors and patients. Taking effect on October 1, the reform aims to help Americans identify the most appropriate and cost-effective treatments while preventing health insurers from blocking physician-approved care.
The new rule, which was finalized through the HHS Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), ensures that healthcare providers can electronically submit prior authorizations, select drugs consistent with a patient's insurance coverage, and exchange electronic prescription information with pharmacies and insurers.
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The initiative complements existing policies from the Centers for Medicare & Medicaid Services (CMS) and seeks to expand interoperability across the healthcare system to reduce administrative burdens.
This victory for American consumers follows a June 2025 roundtable meeting that included Secretary of Health and Human Services Robert F. Kennedy, Jr., CMS Administrator Dr. Mehmet Oz, and major health insurers. At the meeting, insurers pledged six key reforms to enhance transparency and accelerate care decisions for patients and providers in various plans, including Medicare Advantage, Medicaid Managed Care, Medicare Part D, and commercial plans.
"I commend CMS and ASTP/ONC for moving decisively to overhaul our nation's broken prior authorization system," said Secretary Kennedy. "By improving patient outcomes, cutting provider burden, and ensuring full transparency at the point of care, we are delivering on our promise to Make America Healthy Again."
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Dr. Mehmet Oz, CMS Administrator, echoed the sentiment, stating, "This is another step toward delivering on a promise to patients and providers: less red tape, faster answers, and more time focused on care. Prior authorization should never stand in the way of timely treatment, and by working with ASTP/ONC and health insurers, CMS is building a system where decisions are transparent, predictable, and centered on patient needs. This is about making care simpler, fairer, and more affordable."
According to Tom Keane, MD, Assistant Secretary for Technology Policy and National Coordinator for Health IT, the "HTI-4 final rule is a demonstration of ASTP/ONC working collaboratively with our partners at CMS and represents yet another important step in our commitment to ease burdens on providers and speed patients' access to care."
The complementary policies from CMS and ASTP/ONC are expected to:
Accelerate electronic prior authorization: Healthcare providers will be able to submit prior authorizations electronically using certified health IT, leading to faster care authorization decisions. Improve drug cost transparency: Health IT tools will enable prescribers to compare drug prices in real time, helping them identify lower-cost alternatives, especially for patients with Medicare Part D. Reduce administrative burden: Improvements in workflow automation and more transparent decision-making are projected to save millions of hours of clinician time and billions of dollars in labor costs, allowing clinicians to focus more on patient care and less on paperwork.
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