![Centers for Medicare & Medicaid Services Administrator, Mehmet Oz participates in a discussion during the Conservative Political Action Conference (CPAC) at the Gaylord Texan Resort and Conference Center on March 26, 2026 in Grapevine, Texas and [inset] Stock image: Medicare Health Insurance and Social Security card on medical report](https://assets.newsweek.com/wp-content/uploads/2026/04/Copy-of-32-circle-inset-left-14.png?w=1600&quality=80&webp=1)
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By Sam Stevenson
Associate News Editor
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Federal health officials this week proposed sweeping reforms to speed up drug approvals across Medicare, Medicaid and other government-linked health plans.
Long delays tied to insurance approval have become one of the biggest barriers between patients and prescribed treatment, drawing growing scrutiny from doctors and policymakers.
Millions of patients, doctors and insurers would be affected by tighter deadlines, new transparency requirements and a shift toward electronic drug authorization systems.
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Why It Matters
Prior authorization was originally designed to control costs for rare or expensive treatments, but over time it has become a routine hurdle for everyday care.
Federal officials say the system now slows treatment, burdens providers and leaves patients waiting longer than medically necessary.
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A Push To Speed Up Drug Access
The Centers for Medicare & Medicaid Services (CMS) is proposing a major overhaul of how insurance plans approve prescription drugs, with the goal of cutting down long waits for coverage decisions.
The rule would require insurers to decide urgent drug requests within 24 hours and standard requests within 72 hours.
CMS said the changes are intended to reduce administrative friction that often delays treatment.
Health and Human Services Secretary Robert F. Kennedy Jr. said the proposal builds on earlier efforts to eliminate unnecessary hurdles.
“This rule builds on that agreement by making it easier for patients to get the medications they need by minimizing delays and enabling real-time decisions,” Kennedy said.
Modernizing A Fax-Era System
At the center of the proposal is a push to move prior authorization into fully electronic systems. CMS Administrator Dr. Mehmet Oz framed the change as overdue modernization.
“Patients should not have to wait days or weeks for approval to start the medication their doctor prescribed,” Dr. Oz said, adding that the proposal would replace fax machines and fragmented workflows with real-time digital tools.
The rule would extend electronic prior authorization requirements to drugs for the first time, aligning medication approvals with processes already used for many medical services.
CMS said this would reduce back-and-forth between providers and insurers while helping doctors spend less time on paperwork.
“We are standardizing the process, increasing transparency, and ensuring providers can focus on caring for patients instead of navigating red tape,” Oz said.
Who The Rule Would Apply To
If finalized, the requirements would apply broadly across Medicare Advantage, Medicaid, the Children’s Health Insurance Program, and health plans sold through Affordable Care Act marketplaces.
Small group health plans participating in federal exchanges would also be included.
CMS said this alignment is meant to standardize how prior authorization works across public programs, so patients experience similar processes regardless of where they get coverage.
New Transparency Requirements
Beyond faster timelines, the proposal would require insurers to publicly report detailed prior authorization data for prescription drugs. That includes approval and denial rates, appeal outcomes, and how quickly decisions are made.
Plans would also have to report how often they are using electronic systems, giving regulators a clearer picture of whether insurers are actually modernizing.
CMS said public reporting would make it easier for patients, doctors and policymakers to compare how plans handle drug approvals and identify outliers.
Replacing Outdated Standards
The proposed rule would also move insurers away from older technical standards that are still used by some plans.
CMS is proposing the adoption of newer data standards designed to allow real-time electronic submissions and faster sharing of clinical information.
Officials say this could significantly cut down administrative work, reduce errors and speed up decision-making by allowing insurers to review complete documentation more efficiently.
Evidence Of Patient Harm From Drug Delays
Research suggests delays caused by prior authorization are not merely administrative.
A January 2026 systematic review published in The American Journal of Medicine examined 25 studies and found that prior authorization delays were associated with disease exacerbation, preventable hospitalizations, longer hospital stays and lower rates of disease‑free survival across multiple specialties, including oncology and cardiology.
Johns Hopkins researchers involved in the review said delaying access to prescribed treatments can worsen conditions to the point of emergency care, including for children, calling the harm “potentially life‑threatening” rather than theoretical.
Drug‑Specific Data Raises Medicare Concerns
More granular data points to similar risks for prescription medications covered by Medicare.
A Harvard‑led study of Medicare Part D beneficiaries found that when new prior authorization requirements were introduced for established oral cancer drugs, patients were significantly more likely to discontinue treatment and experienced an average delay of nearly 10 days before their next prescription fill.
Researchers warned that, for time‑sensitive conditions such as cancer, even short treatment interruptions can represent a clinically consequential barrier to care rather than a paperwork inconvenience.
What Happens Next
CMS is seeking public input on several related issues, including step therapy practices, cybersecurity risks and how prior authorization works for medical equipment and lab tests.
The agency says most compliance dates would begin in 2027, to deliver improvements to patients as quickly as possible.
The proposal will go through a public comment period before any final rule is issued, leaving room for changes based on feedback from doctors, insurers and patient advocacy groups.
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