CHICAGO — The American Medical Association’s effort to right size prior authorization recently received a boost when the Department of Health and Human Services (HHS) agreed with the AMA to minimize care delays and inefficiencies.
The new HHS policies deliver on strong AMA advocacy, last highlighted in a September 2024 comment letter (PDF), that calls for a streamlined approach that embeds real-time electronic prior authorization into certified electronic health records (EHRs). The policies will standardize how physicians and payers exchange information, paving the way for faster decisions and more timely patient care. The policies require new certification criteria that hard-wire electronic prior authorization, real-time prescription benefit checks, and modernized e-prescribing into certified EHRs.
“Not to overstate it, but this new policy could contribute to the demise of the fax era in medicine. Prior authorization has tied up staff, delayed coverage and kept fax machines humming far past their prime due to insurance companies’ requirements,” said AMA President Bobby Mukkamala, M.D.
Due to these changes, physicians will be able to manage prior authorization requests entirely within their EHR systems, including the ability to:
- Check payer coverage requirements;
- Assemble and submit required clinical documentation;
- Initiate prior authorization requests electronically; and
- Monitor status—all within their existing workflow.
For prescription medications, the policy integrates enhanced electronic prior authorization capability directly into the updated e-prescribing tools. EHR vendors now will be required to support the same technology mandated for Medicare Part D plans–and already required by many state laws. (Note: Physicians can learn more about the technology on electronic prior authorization involving medications through the AMA’s three-part educational video series on this topic.)
The HHS rule also includes a key AMA-supported provision: real-time prescription benefit checks at the point of care. This means physicians can now access patient-specific coverage and out-of-pocket cost information before prescribing—reducing surprises at the pharmacy counter and enabling more informed decisions.
Importantly, these new physician-facing requirements align with the 2024 Interoperability and Prior Authorization Final Rule, ensuring that payers’ systems and EHRs speak the same digital language.
“Thanks to HHS Secretary Kennedy and his team, this is a tangible burden-reduction win for physician practices and a clear path to better outcomes for patients,” Mukkamala said. “By replacing phones, faxes, and portal-hopping with standardized, interoperable EHR connection points, HHS’ new policy turns AMA advocacy into measurable workflow relief and faster decisions. If this is successful, we will continue to push to right size prior authorization so it is not a daily impediment to physicians striving to deliver care to their patients.”
The AMA will now collaborate with HHS, EHR developers, and health plans to drive timely implementation, ensure strong privacy and security practices, and maintain a focus on what matters most – caring for patients without unnecessary delays.
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