Real-time drug pricing access rule to take effect

By Alexandra Murphy / September 2, 2025

A federal rule enabling real-time access to prescription drug pricing, coverage details and prior authorization requirements is set to take effect Oct. 1.

The regulation, finalized in July as part of the CMS Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System final rule, will require healthcare providers to use certified health IT systems to electronically submit prior authorization requests, check real-time prescription drug pricing during patient encounters and share electronic prescription data with pharmacies and insurers.

The rule is designed to reduce administrative burden and enhance point-of-care decision-making, according to a Sept. 2 release from HHS.

The change follows a June roundtable hosted by HHS Secretary Robert F. Kennedy Jr., CMS Administrator Mehmet Oz, MD, and Medicare Director Chris Klomp, which included representatives from major health insurers.

During the meeting, insurers committed to six key reforms intended to improve transparency and reduce administrative delays across Medicare Advantage, Medicaid Managed Care, Medicare Part D, ACA Marketplace and commercial plans, the release said.