Medicare beneficiaries waiting days or even weeks for a drug plan to approve a prescription could see those delays cut sharply under a proposed rule from the Centers for Medicare and Medicaid Services. The proposal would require Medicare drug plans to decide standard prior authorization requests within 72 hours and urgent cases within 24 hours. Public comments on the rule close June 15, and if finalized, compliance would begin October 1, 2027.
Why the 72-hour and 24-hour drug deadlines change the game for patients
Prior authorization, the process by which insurers approve or deny a prescribed drug before covering it, has long been a source of frustration for patients and physicians. For non-drug items and services, CMS already tightened the clock: an earlier final rule known as CMS-0057-F set 72-hour expedited and 7-day standard decision timeframes, with certain requirements taking effect by January 1, 2026. That rule, however, excluded prescription drugs, leaving a gap that the new proposal aims to close.
The new rule, designated CMS-0062-P, would compress the standard drug decision window from the existing multi-day or open-ended timelines down to 72 hours, and it would create a separate 24-hour track for cases a prescriber flags as urgent. Plans that still rely on fax-based or portal-based submission workflows face a steeper climb than those already running electronic prior authorization through NCPDP SCRIPT standards. Plans with electronic systems in place can automate intake, route requests, and return decisions faster. Those still dependent on manual processes will need to overhaul operations before the October 1, 2027 compliance date or risk falling short of the new benchmarks.
CMS frames the rule around electronic standards and public reporting
CMS tied the proposed deadlines to a broader push for electronic prior authorization across Medicare and Medicaid programs. In its official announcement, the agency describes the changes as a way to replace fax and manual workflows with standardized electronic exchanges and to reduce administrative friction for clinicians. CMS emphasizes that faster, automated decisions are intended to cut down on treatment delays that can worsen health outcomes, particularly for beneficiaries managing chronic or complex conditions.
The proposal also leans heavily on transparency. Drug plans would have to publicly report metrics such as average decision times, rates of approvals and denials, and how often they overturn denials on appeal. That reporting requirement would, for the first time, give patients, providers, and regulators a clearer view of how quickly individual plans act on drug authorization requests and how often they say no. Over time, those data could influence beneficiaries’ plan choices and spur lagging plans to invest in more efficient technology and staffing.
The CMS-0057-F final rule that preceded this proposal applied to impacted payers but excluded certain qualified health plan issuers. The new drug-specific rule extends the agency’s reach into Medicare Advantage prescription drug plans and other affected entities that handle pharmacy benefits. CMS has published supporting materials, including a comment guide, summary of provisions, and an NCPDP workflow explainer, on its dedicated policy page, signaling that the agency expects plans and vendors to start planning well before the 2027 compliance date.
In a separate fact sheet, CMS highlights how the drug rule aligns with broader interoperability efforts. The agency points to standardized data formats and application programming interfaces as the backbone for real-time exchange between prescribers, pharmacies, and plans. By embedding prior authorization into electronic prescribing workflows, CMS argues, clinicians should be able to see coverage requirements at the point of care and avoid the back-and-forth that now often occurs after a prescription is sent.
Open questions before the June 15 comment deadline
Several gaps remain in the public record. CMS has not published data showing current average decision times or denial rates for Medicare drug prior authorization, making it difficult to quantify how much faster approvals might become under the new rule. Stakeholders are likely to press the agency to release baseline metrics or, at a minimum, explain how it will use the newly required reporting to monitor plan performance and enforce the timelines.
Another unresolved issue is how plans will define and manage “urgent” requests. The proposal relies on prescribers to flag cases where a 24-hour turnaround is medically necessary, but it leaves room for plans to establish their own review processes. Physician groups may ask CMS to clarify that plans cannot routinely downgrade urgent requests or impose additional documentation hurdles that effectively blunt the benefit of the expedited track.
The operational burden on smaller plans and pharmacy benefit managers is also likely to surface in comments. While large national carriers may already be investing in NCPDP SCRIPT-based systems, regional and niche plans could face significant costs to upgrade legacy platforms, integrate with prescriber electronic health records, and train staff. CMS has framed the long lead time to October 1, 2027 as a cushion, but commenters may seek phased implementation, technical assistance, or flexibility for entities starting from a largely manual baseline.
Finally, beneficiary advocates are expected to focus on how the rule will be communicated to patients. Faster decisions only help if enrollees understand their rights and know when to push back if a plan exceeds the 72-hour or 24-hour limits. Commenters may urge CMS to require clear notice language on denial letters, plan websites, and Medicare materials so that patients and caregivers can recognize when a delay is out of compliance and pursue appeals or complaints.
As the June 15 deadline approaches, the debate will center less on whether delays are a problem and more on how aggressively CMS should move to standardize and enforce electronic prior authorization for drugs. The final contours of CMS-0062-P will determine whether the promised 72-hour and 24-hour clocks translate into real-world improvements at the pharmacy counter or remain aspirational benchmarks that only the best-prepared plans can consistently meet.
David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
