Medication-access standards advance

Federal officials have moved medication access deeper into the plumbing of health care software, requiring certified systems to handle drug pricing, e-prescribing and prior authorization in more standardized ways. (healthit.gov) The Assistant Secretary for Technology Policy and the Office of the National Coordinator issued the HTI-4 final rule on July 31, 2025, and made it effective on October 1, 2025. The rule was published with the fiscal 2026 Medicare hospital payment rule and updates federal certification criteria for health information technology. (healthit.gov) At the center of the rule are three medication workflows: electronic prescribing, real-time prescription benefit checks, and electronic prior authorization. In practice, that means certified electronic health record systems must be able to surface drug coverage and cost information, exchange prescription data, and support electronic approval requests to insurers. (healthit.gov) A real-time prescription benefit check works like a live price tag inside the doctor’s ordering screen. The new certification criterion is meant to let clinicians and patients compare a prescribed drug with covered alternatives and expected out-of-pocket costs before the prescription is sent. (healthit.gov) Prior authorization is the insurer approval step that can stall a prescription after a clinician has already chosen a treatment. HTI-4 adds certification criteria and related application programming interface standards so providers can request coverage requirements, assemble documentation and receive status updates inside their health IT systems instead of relying on phone calls or fax. (healthit.gov) The rule follows a separate Centers for Medicare & Medicaid Services interoperability rule released on January 17, 2024, that required faster and more electronic prior authorization for many medical items and services across Medicare Advantage, Medicaid, Children’s Health Insurance Program and federally facilitated exchange plans. HTI-4 extends the standards work on the health information technology side to prescription workflows. (cms.gov) The pressure for change has been building. In the American Medical Association’s 2024 physician survey, 93% of doctors said prior authorization delays care, and 89% said it contributes to burnout. (ama-assn.org) The policy shift also changes what vendors have to prove. Medication access is no longer just a complaint about paperwork; it is increasingly a testable exchange of data between electronic health records, pharmacies and payers, with certification criteria that can be demonstrated in product workflows. (pharmaceuticalcommerce.com) Federal officials cast the rule as one step in a longer campaign to make prescription decisions faster and more visible at the point of care. The next fight is less about whether these standards exist than whether vendors, providers and insurers implement them in ways patients can actually feel at the pharmacy counter. (hhs.gov)