Comment on CMS-2026-1255-0001
American Medical AssociationSupportAdvocacy
Summary: The American Medical Association (AMA) supports the proposed rule to modernize and standardize drug prior authorization (PA) through interoperability and FHIR-based APIs. They advocate for specific technical requirements, including mandatory conformance testing, evidence-based PA criteria, and aligned implementation timelines between payers and EHR vendors to reduce physician burnout and improve patient care.
On behalf of the physician and medical student members of the American Medical Association (AMA), I appreciate the opportunity to offer our attached comments to the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) on the Notice of Proposed Rulemaking (Proposed Rule) extending interoperability and prior authorization (PA) requirements to drugs for Medicare Advantage organizations (MAOs), state Medicaid and CHIP fee-for-service (FFS) programs, Medicaid and CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs), published in the Federal Register on April 14, 2026. We offer detailed comments below and provide targeted feedback on key provisions. We look forward to working with the Administration on these important policy proposals.