HHS Finalizes Rules for E-Prescribing and Prior Authorization: Adopting FHIR Standard
HHS finalizes e-prescribing and prior authorization rules | Healthcare IT
HHS finalized new rules governing e-prescribing and prior authorization, including FHIR certification requirements for prior authorization.
Summary
The U.S. Department of Health & Human Services (HHS) has finalized a series of new rules regarding electronic prescribing and prior authorization. These rules mandate real-time prescription benefit checks at the point of care and formally adopt FHIR certification for the prior authorization process.
Key Players
Details
The U.S. Department of Health & Human Services (HHS) released new regulations to standardize technology use in electronic prescribing and prior authorization, aiming to reduce administrative burdens on clinicians and improve drug cost transparency. Key requirements include mandatory real-time prescription benefit checks at the point of care. Critically, FHIR certification is formally adopted for the prior authorization process. The HTI-4 rule requires providers to handle prior authorizations in real time during patient encounters using health IT, supporting standardized electronic exchange via HL7's FHIR standard. This policy aligns with CMS requirements and mandates that participating providers report on an electronic prior authorization measure starting in 2027. For developers, the final rule establishes specific standards for API functionality certification (NCPDP SCRIPT), requiring a transition from older versions to newer ones by 2028. These changes represent a major push toward interoperability and standardized care management across US healthcare systems.
Technology Note
FHIR（Fast Healthcare Interoperability Resources）は医療データ交換の国際標準。このエントリの関連技術: FHIR
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