On December 31, 2020, the Centers for Medicare and Medicaid Services (CMS) released a final regulation requiring Medicare Part D prescription drug plans to support a new electronic prior authorization transaction standard, as required by the 2018 SUPPORT Act.
The SUPPORT Act required CMS to implement new e-prescribing standards for Medicare Part D programs to ensure secure electronic prior authorization request and response messages. This new electronic prior authorization standard is intended to allow prescribers to see that a drug is subject to prior authorization while they are prescribing it.
In this final rule, CMS amended the Part D e-prescribing regulations to require Part D plan sponsors to support version 2017071 of the National Council for Prescription Drug Programs (NCPDP) SCRIPT standard in communicating with providers who prescribe Part D-covered drugs to Part D-eligible individuals.
NextGen Healthcare and partner Surescripts support the SCRIPT version 2017071 standard. This new requirement for Part D sponsors should mean a broader opportunity for clients to utilize electronic prior authorizations to streamline the e-prescribing process for patients.
CMS will begin enforcing these requirements on January 1, 2022, although Part D sponsors may choose to implement the new transaction standard earlier. (See here and here for more details.)