When a Medicare patient’s doctor prescribes a new medication that requires prior authorization, the insurance plan has to decide whether it will pay before the patient can fill the prescription. That review can drag on for days. Treatment stalls. Some patients pay out of pocket. Others switch to a less effective drug or stop pursuing the prescription entirely.
A proposed federal rule now open for public comment would put hard time limits on that process: 72 hours for standard prior authorization requests on prescription drugs, and 24 hours when a physician flags the case as urgent.
The Centers for Medicare & Medicaid Services (CMS) published the proposal, designated CMS-0062-P, in the Federal Register on April 14, 2026. The comment window closes June 15, 2026, giving patients, physicians, insurers, pharmacies, and advocacy groups roughly two months to weigh in on a policy that could reshape how more than 50 million Medicare drug plan enrollees access their medications, according to CMS enrollment data.
What the rule would actually change
Prior authorization is the gatekeeping step insurers use to decide whether they will cover a prescribed drug before the patient picks it up. A doctor or pharmacist submits a request, the plan reviews it against clinical criteria, and the patient waits for a yes or no.
Medicare Part D regulations already impose a 72-hour clock for standard coverage determinations and a 24-hour clock for expedited ones, under 42 CFR Part 423, Subpart M. But drugs covered under Medicare’s medical benefit (Part B), such as certain infused or injected medications administered in a clinic, have not been subject to the same structured timelines. Authorization turnaround on the Part B side has been less predictable.
CMS-0062-P would extend the 72-hour and 24-hour deadlines to Part B drug authorizations, creating a single standard across both sides of Medicare’s drug coverage. It would also require plans to process requests electronically using two interoperability standards: FHIR (Fast Healthcare Interoperability Resources) for structured data exchange between providers and plans, and NCPDP (National Council for Prescription Drug Programs) for pharmacy claims. The aim, according to a CMS fact sheet, is to replace the fax-and-phone workflows that still dominate parts of the system with automated, trackable digital channels.
In its press release, CMS said the proposal is part of a broader push to cut administrative friction and speed patient access to medications. The agency cited evidence that prior authorization delays can postpone treatment and, in some cases, cause patients to abandon prescribed therapies altogether.
How it builds on earlier reforms
This proposal follows a related rule CMS finalized in January 2024. That rule, CMS-0057-F, imposed 72-hour expedited and seven-day standard prior authorization timelines for non-drug items and services under Medicare Advantage, Medicaid managed care, and CHIP managed care. Prescription drugs, however, were explicitly excluded from its scope.
CMS-0062-P is designed to close that gap. By bringing drug authorizations into a parallel framework and layering on pharmacy-specific interoperability requirements, the agency is pushing toward a system where drug approvals move on comparable timelines whether the claim runs through the pharmacy benefit or the medical benefit.
The proposal also overlaps with ongoing congressional interest in prior authorization reform. The Improving Seniors’ Timely Access to Care Act, which has drawn bipartisan support in recent sessions, targets similar issues around electronic processing and decision timelines for Medicare Advantage. CMS-0062-P advances several of those goals through the regulatory track rather than waiting for legislation.
Where the debate will focus
Several points of friction are likely to surface during the comment period.
Baseline data is thin. CMS has not published comprehensive figures on how long prior authorization decisions actually take today across Medicare drug plans. Without that baseline, it is difficult to measure how many beneficiaries would see a meaningful reduction in wait times. The American Medical Association’s 2024 prior authorization physician survey found that 94% of physicians reported care delays associated with prior authorization and that nearly one in three reported that prior authorization led to a serious adverse event for a patient. Those numbers, drawn from physicians across all payer types, suggest the problem is widespread, but Medicare-specific timing data remains scarce.
Implementation costs are uncertain. Transitioning to FHIR- and NCPDP-based workflows will require new software, testing, and staff training. Smaller plans and independent physician practices may argue the investment is steep, particularly if they must support multiple prior authorization tools across different payers. How CMS structures compliance timelines and enforcement will determine whether the shift feels like relief or another layer of technical obligation.
“Urgent” needs sharper criteria. The proposed rule sets a 24-hour clock for urgent cases but does not, in its public summaries, spell out granular clinical criteria for that designation. Consider a patient with aggressive cancer whose oncologist prescribes a targeted therapy: does the case automatically qualify as urgent, or must the physician submit additional documentation to trigger the faster clock? Patient advocates may push CMS to require plans to default to expedited processing whenever a physician attests that a delay could seriously jeopardize a patient’s health. Plans may seek flexibility to prevent the urgent label from being applied so broadly that it strains review capacity.
Faster decisions do not guarantee more approvals. A plan can still deny coverage within the required timeframe, leaving the patient to navigate a multi-step appeals process. Organizations like the American Medical Association, which has long documented physician-reported patient harm from authorization delays, may urge CMS to pair timing rules with transparency requirements on denial rationales. If clinicians can see exactly why a request was denied, they can adjust prescriptions or supply additional documentation rather than restarting from scratch.
Enforcement is the open question. The proposed rule sets deadlines, but what happens if a plan misses them? Whether CMS builds in automatic approval provisions, financial penalties, or reporting requirements for missed deadlines will likely be one of the most contested elements in the comment record. A deadline without consequences is a suggestion, not a mandate.
What could shift before the rule is finalized
CMS routinely revises proposed rules based on public input. If insurers warn that the implementation timeline is too aggressive, the agency could phase in requirements or carve out certain complex drug categories. If patient and provider groups argue the standards do not go far enough, CMS may face pressure to tighten oversight, require plans to publicly report authorization turnaround times and denial rates, or add automatic approval triggers when plans miss deadlines.
The comment portal on the Federal Register is open now. Anyone can submit feedback: a Medicare beneficiary describing how a prior authorization delay affected their care, a hospital system detailing operational costs, a pharmacy chain flagging workflow concerns. CMS weighs all of it. Individual patient stories carry real weight in the rulemaking record alongside detailed legal or actuarial analyses from industry groups.
How to submit a comment before June 15
Comments can be submitted electronically through the Federal Register listing for CMS-0062-P. Responses do not need to be technical or written in legal language. The deadline is June 15, 2026, at 11:59 p.m. Eastern Time.
Warren Cohen is a finance writer based in Phoenix, Arizona, covering personal finance topics including credit, banking, and beginner investing. He earned his degree in business administration from Arizona State University and began his career working in consumer finance, where he gained direct experience with lending and credit systems. He now writes for personal finance websites and fintech platforms, focusing on clear, practical content that helps readers make informed financial decisions.
