Expert: Can Health Systems Meet CMS’ 24-Hour Prior Authorization Rule?
Expert: Can Health Systems Meet CMS' 24-Hour Prior Authorization Rule?
Summary
Joseph Kleiman, president of Buzz Health, warned that current e-prescribing infrastructure is unprepared for new proposed Centers for Medicare & Medicaid Services (CMS) mandates. He cited fragmented systems, reliance on outdated processes like fax and phone calls, and a lack of standardized data exchange as major obstacles.
Details
In an interview with Pharmacy Times, Joseph Kleiman, president of Buzz Health, discussed the readiness of current e-prescribing infrastructure to meet new proposed Centers for Medicare & Medicaid Services (CMS) mandates. These mandates require 24-hour and 72-hour prior authorization timelines and real-time, Fast Healthcare Interoperability Resources (FHIR)–based workflows. Kleiman emphasized that the industry is not prepared, citing fragmented systems, reliance on outdated processes such as fax and phone calls, and lack of standardized, automated data exchange. He highlighted that gaps in interoperability, consistency, and real-time information sharing continue to slow prior authorization workflows. From a clinical perspective, he explained that reducing these friction points requires addressing systemic issues beyond just technology. The discussion underscores the critical link between meeting regulatory mandates (like CMS's PA rules), ensuring patient access, managing affordability, and maintaining medication adherence.
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