A new rule from HHS set to go into effect on Oct. 1 will allow health care providers and patients to determine the drug prices for prescription drugs and potential alternatives based on a patient’s insurance plan.
In addition, providers will be able to submit prior authorizations — requests to cover more expensive medications or medical procedures — electronically, speeding up those decisions.
The drug price transparency tool addresses “affordability issues at the time that a product is prescribed, by comparing the patient-specific cost of a product to the cost of a suitable alternative and comparing prescription costs at different pharmacies,” according to HHS background slides on the HTI-4 Final Rule.
The document also states that electronic prior authorization “addresses processes that have contributed significantly to patient and provider burden, for instance, delays experienced by patients and clinicians as they seek to satisfy the requirements associated with prior authorization rules set by payers.”
In June, HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz met with health insurance executives to discuss changes to prior authorization policies.
