The U.S. Department of Health and Human Services (HHS) has finalized a rule that will give patients and doctors unprecedented real-time access to prescription drug prices, out-of-pocket costs, and prior authorization requirements starting October 1.
The change is designed to help clinicians select cost-effective treatments that align with patients’ insurance coverage while curbing delays caused by prior authorization. Under the new policy, health care providers using certified health IT systems will be able to submit prior authorizations electronically, exchange prescription data with insurers and pharmacies, and compare drug costs during patient visits.
The rule, developed by the HHS Office of the National Coordinator for Health Information Technology (ASTP/ONC), builds on recent reforms from the Centers for Medicare & Medicaid Services (CMS) to expand interoperability and reduce administrative burdens.
The announcement follows a June 2025 roundtable with HHS Secretary Robert F. Kennedy, Jr., CMS Administrator Dr. Mehmet Oz, Medicare Director Chris Klomp, and major insurers representing most U.S. health coverage. Insurers pledged six reforms to streamline approvals, increase transparency, and speed care decisions across Medicare Advantage, Medicaid Managed Care, Medicare Part D, the Health Insurance Marketplace®, and commercial plans.
“I commend CMS and ASTP/ONC for moving decisively to overhaul our nation’s broken prior authorization system,” Kennedy said. “We are cutting provider burden, ensuring transparency at the point of care, and delivering on our promise to Make America Healthy Again.”
Dr. Oz called the reform “another step toward less red tape, faster answers, and more time focused on care,” emphasizing that prior authorization should not delay treatment.
Tom Keane, MD, Assistant Secretary for Technology Policy and National Coordinator for Health IT, said the rule demonstrates federal agencies’ commitment to nationwide interoperability. “We remain focused on lowering costs and improving care by ensuring data flows seamlessly between providers and payers,” he said.
Key provisions of the rule include:
Faster approvals: Electronic prior authorization through certified systems, resulting in quicker and more transparent decisions.
Drug cost transparency: Tools allowing prescribers to compare real-time drug prices and suggest lower-cost alternatives within a patient’s coverage.
Reduced administrative burden: Streamlined workflows expected to save clinicians millions of hours and billions of dollars, freeing up more time for patient care.
HHS officials said the reforms mark a significant step toward a more efficient, transparent, and patient-centered health system.
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