The final rule (CMS-0057-F) represents a critical step toward alleviating the significant challenges long-faced by those navigating the traditional prior authorization process.

Here are some key takeaways:

• Medicare and Medicaid plans should strategize and implement changes for the final CMS rule, which has an implementation deadline of January 1, 2027 (and January 1, 2026 for certain operational provisions).
• Digitizing prior authorization will solve many of the current issues facing health plans, patients, and providers because it will improve data exchange and collection and speed up the authorization process.
• Health plans that implement intelligent prior authorization to comply with upcoming prior authorization and utilization management regulations can also reduce provider burden and, ultimately, improve patient outcomes.