NHIA Urges CMS to Recognize Pharmacy-Initiated Prior Authorization for Home Infusion

NHIA submitted comments to CMS on a new proposed rule on interoperability and prior authorization for drugs. While NHIA is mostly supportive of standardizing prior authorization (PA) processes for Medicare-covered drugs, it wants CMS to know that home infusion may not fit neatly into processes designed for medical and pharmacy benefits. The association issued comments in response to a proposed rule on interoperability standards and prior authorization aimed at improving patient access and reducing administrative burden. NHIA pointed out that maintaining separate prior authorization processes for prescription medicines covered under the medical benefit and pharmacy benefit may create operational challenges at the point of care. NHIA also urged CMS to recognize pharmacy-initiated prior authorization as a standard practice in home infusion and require impacted payers to accept prior authorization submissions from dispensing pharmacies when a valid prescription has been issued by a prescriber.