HHS Final Rule Expands Real-Time Prescription Access, Eases Prior Authorization Burdens

The US Department of Health and Human Services (HHS) announced a regulatory reform that will transform how physicians and patients access prescription drug information. Beginning October 1, doctors will have real-time visibility into drug prices, out-of-pocket costs, and prior authorization requirements—changes designed to speed care decisions and lower costs while limiting insurer interference in physician-approved treatments.

For oncology, where treatment decisions often hinge on time-sensitive, high-cost therapies, the rule promises to reduce delays that have historically disrupted care. The policy ensures providers using certified health IT systems can electronically submit prior authorizations, align prescriptions with a patient’s insurance coverage, and seamlessly exchange prescription data with pharmacies and payers. These reforms build on earlier Centers for Medicare & Medicaid Services (CMS) initiatives and represent a coordinated federal effort to expand interoperability while reducing administrative waste. For oncologists, whose patients face particularly complex authorization barriers for chemotherapy, immunotherapy, and targeted agents, the potential impact could be profound.

The final rule emerged from the Office of the National Coordinator for Health Information Technology (ASTP/ONC) following a June 2025 roundtable where Secretary Kennedy, CMS Administrator Dr Mehmet Oz, Medicare Director Chris Klomp, and executives from major insurers pledged reforms covering nearly 80% of Americans. Insurers agreed to streamline authorization processes, increase transparency, and implement consistent electronic standards across Medicare Advantage, Medicaid Managed Care, Medicare Part D, Marketplace, and commercial coverage.

For oncology practices, the ability to submit and track prior authorizations electronically could significantly reduce administrative overhead. The rule also requires health IT systems to provide real-time drug cost information, giving oncologists insight into formulary coverage and lower-cost therapeutic alternatives at the point of prescribing. This could be especially valuable in avoiding financial toxicity for cancer patients who often face substantial out-of-pocket costs.

Tom Keane, MD, Assistant Secretary for Technology Policy and National Coordinator for Health IT, highlighted that ASTP/ONC is advancing interoperability nationwide, enabling providers and payers to adopt common data standards that reduce duplication and accelerate innovation.

The reforms are expected to reduce workflow bottlenecks, saving clinicians millions of hours that would otherwise be spent navigating paperwork. For oncology providers, where prior authorization appeals can delay urgent treatments, streamlined electronic submissions may cut days from the process. By automating documentation and aligning payer requirements, HHS estimates the reforms could save billions in administrative costs while allowing physicians to devote more time to direct patient care.

For oncology leaders and payers, the rule signals a shift toward greater transparency and accountability in how therapies are authorized and reimbursed. By embedding cost, coverage, and authorization data directly into electronic prescribing systems, HHS aims to eliminate barriers that slow cancer care.

Reference

Americans to gain new access to real-time prescription drug price information. U.S. Department of Health and Human Services. September 2, 2025. Accessed September 26, 2025. https://www.hhs.gov/press-room/hhs-prescription-drug-price-transparency-rule.html