ASTP/ONC has released a final rule related to health IT certification requirements around electronic prescribing, real-time prescription benefits, and electronic prior authorization.

New certification requirements will allow users to compare drug prices and identify lower cost alternatives. In what is called the HTI-4 rule, ASTP/ONC is implementing the provisions of the Consolidated Appropriations Act (CAA) of 2021 by adding a new certification criterion enabling prescriber access to prescription benefit information at the point of care. This policy complements requirements in the Medicare Part D program and is based on common standards for real-time prescription benefit exchange developed by the National Council for Prescription Drug Programs (NCPDP).

ASTP/ONC also has updated the baseline standard for electronic prescribing for the first time in five years.

The “electronic prescribing” certification criterion now incorporates an improved version of the NCPDP SCRIPT standard. ASTP/ONC adopted the standard last year in collaboration with CMS to support nationwide interoperability between prescriber systems and Part D sponsors. It also now require that prescriber systems support functionality for electronic prior authorization of prescriptions, which until now was optional in the program.

During a media briefing, ASTP/ONC’s deputy director in the Alignment and Engagement Division of the Office of Policy, Alex Baker, said that as part of this HDI-4 final rule, they are finalizing the adoption of three certification criteria that can support more efficient management of electronic prior authorization tasks and reduce administrative burden for providers. 

“These certification criteria and the health IT modules that get certified to these criteria will enable providers to interact with the prior authorization APIs that CMS required certain payers that it regulates to establish as part of the CMS interoperability and prior authorization final rule, which they released at the beginning of last year,” Baker said, and use of technology certified to these criteria will also support healthcare providers that are participating in the Medicare Promoting Interoperability program and the MIPS Promoting Interoperability performance category, who must report on an electronic prior authorization measure beginning in 2027, which CMS also finalized as part of that interoperability and prior authorization final rule in 2024. 

The first of the three criteria is related to certifying health IT systems to do coverage requirements discovery. Baker said this would allow a provider within their workflow to request information from payers about coverage requirements for different items and services. 

The second is a criterion around documentation templates and rules that provide a mechanism for clinicians and other EHR users to navigate and quickly assemble the information needed to support a prior authorization request according to the payers requirements.

The third is a criterion around prior authorization support that would enable the submission of the prior authorization request from health IT systems, as well as supporting follow-up tests such as checking the status of previously submitted requests. 

All three of these criteria are based on FHIR implementation specifications developed by the HL7 Da Vinci project, Baker added. Those are the standards CMS has also identified in their rule as the standards that implementers should use to stand up those APIs that they've required for prior authorization.