- Key Takeaways
- CMS 0057 (CMS-0057-F) regulates payers, not providers, but reshapes prior authorization turnaround, denial transparency, and electronic submission for everyone who submits PA requests.
- January 1, 2026 introduced a 7 day standard / 72 hour expedited decision window and mandatory specific denial reasons; these are already in effect.
- January 1, 2027 is the deadline for four required FHIR APIs: Patient Access, Provider Access, Payer to Payer, and Prior Authorization.
- Traditional Medicare and standalone Part D are excluded; the rule covers Medicare Advantage, Medicaid/CHIP, and FFE qualified health plans.
- Provider readiness (EHR/clearinghouse FHIR support, tracking denial reasons now) determines whether a practice actually captures the efficiency gains once payers comply.
What Is CMS 0062?
CMS 0062, officially CMS-0062-P, is the 2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule. CMS released it on April 10, 2026, as a direct follow-on to CMS-0057-F, the Interoperability and Prior Authorization Final Rule finalized in 2024. CMS-0057 deliberately excluded drugs from its prior authorization requirements. CMS-0062 proposes to close that gap.
As of this writing, CMS-0062-P remains a proposed rule. The comment period closed June 15, 2026, and CMS has not announced when a final rule will be issued. Nothing in this proposal is binding yet.
What CMS 0062 Would Require, If Finalized
- Electronic prior authorization for drugs. Payers would need to support electronic PA for drugs covered under the medical benefit, and separately, for pharmacy benefit drugs using NCPDP standards (SCRIPT, Formulary and Benefit, Real-Time Prescription Benefit).
- Faster decisions. Proposed timeframes tighten to 24 hours for most Medicaid and CHIP drug requests, and 72 hours standard, 24 hours expedited, for QHP issuers.
- Denial reasons extended to drugs. The specific, actionable denial reason requirement already in effect for non-drug prior authorization under CMS-0057 would extend to cover all drug prior authorization denials as well.
- FHIR-based standards adoption. The rule proposes adopting HL7 FHIR as an official standard for prior authorization transactions under HIPAA Administrative Simplification, alongside Da Vinci Implementation Guides such as CRD, DTR, and PAS.
- A centralized endpoint registry. CMS proposes to publish payer API endpoint information in one centralized location, making it easier to check which payers have which APIs live instead of checking each payer’s site separately.
- Broader payer scope. Small group market QHP issuers on FF-SHOP exchanges would newly be covered, in addition to the payers already covered under CMS-0057.
- New reporting. Payers would report API endpoint documentation within 60 days of a final rule’s effective date, and drug prior authorization metrics beginning in 2028 for 2027 data.
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Revenue Cycle Management
Proposed Timeline
Milestone | Date | Status |
Proposed rule released | April 10, 2026 | Confirmed |
Public comment period closed | June 15, 2026 | Confirmed |
Final rule issued | Not yet announced | Pending |
Drug prior authorization provisions take effect | October 1, 2027 | Proposed, not final |
HIPAA-covered entities adopt FHIR standards | 24 months after effective date (36 months for small plans) | Proposed, not final |
First drug PA metrics reported | 2028 (covering 2027 data) | Proposed, not final |
Five Related Questions CMS Is Also Asking About
Beyond the binding proposals, CMS included five separate Requests for Information seeking public input on related topics it may address in future rulemaking:
- Expanding electronic event notifications (ADT alerts) to support value-based care and care coordination
- Strengthening cybersecurity defenses against hacking and ransomware across the interoperability ecosystem
- Improving oversight, testing, and transparency of payer APIs generally
- Streamlining step therapy processes through technology and data sharing
- Reducing prior authorization barriers for laboratory tests and DMEPOS items
None of these are proposed requirements yet. They signal where CMS may be headed next, which is worth watching even though nothing here is actionable today.
How CMS 0062 Relates to CMS 0057
CMS-0057-F, finalized in 2024, already requires payers to build Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization APIs by January 1, 2027, with process rules like 7-day/72-hour decision windows already in effect since January 2026. CMS-0057 explicitly left drugs out of that scope. CMS-0062 is where drugs get added back in, using the same API infrastructure payers are already required to build under CMS-0057, with drug-specific standards (NCPDP) layered on top for pharmacy benefit medications. For background on the underlying rule this builds on, see our CMS 0057 explainer.
What This Means for Providers, Even Before It's Final
Nothing in CMS-0062 is enforceable yet. But providers who prescribe or manage drugs requiring prior authorization, especially specialty and Part B drugs, have reason to watch this closely:
- The infrastructure is already being built. Because CMS-0062 rides on the same APIs required under CMS-0057, payer readiness for one signals readiness for the other. Asking payers about CMS-0057 API status now is a reasonable proxy for CMS-0062 readiness later.
- Two different data standards will apply to drugs. Medical benefit drugs would follow the existing FHIR-based Prior Authorization API; pharmacy benefit drugs would follow separate NCPDP standards. Practices managing both drug types should expect two different workflows, not one.
- The planning window is real, but finite. With no final rule yet, October 2027 could shift. Practices that wait for certainty before engaging risk having less runway than those preparing now.
How Neolytix Helps
Neolytix has managed prior authorization and revenue cycle operations for providers for over 14 years, tracking payer-specific turnaround times and denial patterns as a standard part of RCM management. As payer infrastructure for both CMS-0057 and CMS-0062 develops, that operational visibility extends naturally to drug prior authorizations, since the same escalation and resubmission practices apply once payers roll out compliant processes. For the broader prior authorization picture, see our Prior Authorization Cheat Sheet.
Conclusion
CMS 0062 is not yet law, and providers are not required to do anything about it today. But it is the clearest signal yet that drug prior authorization is headed toward the same electronic, FHIR-based standards already reshaping medical benefit prior authorization under CMS-0057. The proposed October 2027 deadline gives providers and payers a planning window, not an active deadline, and that window is the useful part. Organizations that track how CMS-0057 compliance is going at their top payers now will have a head start when CMS-0062, or something close to it, becomes final.
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Frequently Asked Questions
Is CMS 0062 a final rule?
No. As of this writing, CMS-0062-P is a proposed rule. The comment period closed June 15, 2026, and no final rule has been issued.
How is CMS 0062 different from CMS 0057?
CMS-0057-F, finalized in 2024, covers general prior authorization APIs and process rules but excludes drugs. CMS-0062-P proposes to add drug prior authorization requirements, including denial reasons, using the same API infrastructure.
What is the CMS 0062 compliance deadline?
The proposed rule targets October 1, 2027 for most drug prior authorization provisions, but this date is not final and could change.
Does CMS 0062 apply to all drugs?
As proposed, it covers both medical benefit drugs (using the existing FHIR Prior Authorization API) and pharmacy benefit drugs (using separate NCPDP standards).
Do providers have to do anything under CMS 0062 right now?
No. The rule is not final, and even once finalized, it regulates payers, not providers directly. Providers benefit from the changes payers must make.
