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MARCH 12, 2024

New CMS Rules Streamline PAs but Exclude Drugs

By Myles Starr

The Centers for Medicare & Medicaid Services (CMS) announced new rules for government-sponsored health insurance companies requiring them to invest in a digital technology called an application programming interface (API) that will ensure prior authorization (PA) requests are swiftly addressed. However, these new rules apply to PAs for medical procedures and not prescription drugs.

Although affected payors “may have upfront implementation costs, they are outweighed by the