Federal and state healthcare policy changes affecting access, benefits, eligibility, and care delivery.
CMS has proposed new rules aimed at speeding up prior authorization for prescription drugs and making the process more transparent for patients and clinicians. The changes are not final yet, but they could affect several major coverage groups if adopted.
CMS has already finalized some prior authorization changes, and it has also proposed new drug-related rules that are not final yet. Here’s how the new timeline works, who may feel it, and what to do if care is delayed or denied.
CMS and FDA have announced RAPID, a new pathway meant to shorten Medicare coverage decisions for certain breakthrough medical devices. The change could help some patients get access sooner, but it applies only to a narrow set of devices and still depends on formal federal review.
CMS has proposed extending its electronic prior-authorization rules to prescription drugs, with comments open through June 15, 2026. If finalized, the change could reduce paperwork and speed some decisions, but prior authorization would still exist and results could vary by plan.
CMS has proposed shorter deadlines and more electronic processing for prescription-drug prior authorizations in several federal health coverage programs. The plan would not end prior authorization, but it could reduce delays and improve transparency around denials and appeals.
CMS has proposed a new rule that would expand electronic prior authorization to drugs and add faster decision timelines for some plans. The change is not final yet, and the details could still change after public comment closes on June 15, 2026.
CMS has proposed changes that could make prior authorization for certain drugs faster and more electronic for people in Medicare Advantage, Medicaid managed care, CHIP, and Marketplace plans. The rule is still only proposed, and details can change after public comment closes on June 15, 2026.
Not much right away for most patients in 2026. CMS has proposed extending many prior-authorization rules to prescription drugs, but the biggest changes would not begin until October 1, 2027 if the rule is finalized, and public drug prior-authorization reporting would generally start in 2028 using 2027 data.
CMS has proposed new electronic prior-authorization rules for some drug coverage in Medicare Advantage, Medicaid, CHIP, and certain ACA marketplace plans, but nothing changes yet because the rule is still only a proposal.
More than 23 million people selected or were automatically re-enrolled in ACA Marketplace coverage for 2026, according to CMS. But for many households, the end of enhanced pandemic-era savings on December 31, 2025, may mean higher monthly premiums even while enrollment remains strong.
CMS has proposed a rule to move more drug prior authorization into electronic workflows and standardize how plans handle requests. If finalized, the change could make some pharmacy delays shorter and denials easier to track, but the rule is still only proposed.
CMS has proposed new rules to speed up prior authorization for prescription drugs and make denials more transparent. The changes are not final yet, so patients should not expect immediate nationwide changes.
CMS has proposed new rules that would extend prior-authorization interoperability requirements to prescription drugs. The plan would not end prior authorization, but it could make requests more electronic, more standardized, and faster to answer for some health plans.
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