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HTI-4 Final Rule Cements E-Prescribing, Real-Time Prescription Benefit Check, and Electronic Prior Authorization Mandates

The HTI-4 Final Rule, adopted July 31, 2025, updates the ASTP/ONC Health IT Certification Program with new standards for electronic prescribing, real-time prescription benefit checks, and electronic prior authorization to reduce administrative burden and improve healthcare efficiency.

Key compliance deadlines:
  • January 1, 2027—mandatory inclusion of electronic prior authorization and real-time prescription benefit capabilities in the Base EHR definition.
  • January 1, 2028—upgrade to NCPDP SCRIPT Standard version 2023011.

Get the details here.

ONC Proposes HTI-2 Rule to Speed Access to Patient Data, Streamline Workflow, Ease Prior Authorization Pain Points On July 10, 2024, the Office of the National Coordinator for Health Information Technology (ONC) released the HTI-2 proposed rule for advancing the next stage of interoperability, aiming to streamline patient data exchange through tech-enabled access points leading to improved outcomes.   

The rule requires a large overhaul of e-prescribing, while simultaneously expanding interoperability and prior authorization systems that support patient care and public health goals. It includes five new certification criteria, six standards updates, and nine revised certification criteria that will impact roadmap development in 2025, 2026, and 2027.  

HTI-2 Top Takeaways:    

Total E-Prescribing Upgrade Required: Expands CMS’ recently finalized e-prescribing standard, requiring the adoption of NCPDP SCRIPT Standard 2023011, Formulary and Benefit Version 60, and electronic prior authorization.  

Streamlined Prior Authorizations: Mandates the integration of standardized APIs for medical prior authorization to improve data exchange between health IT systems and payers, and to reduce delays and administrative burdens for patients and providers.  

Enhanced Real-Time Price Transparency: Requires health IT systems to include functionalities that allow for immediate access to drug pricing information for patients.  

Improved Data Interoperability: Mandates standardized APIs across different health IT systems, promoting better coordination and continuity of care.

Read and comment on the final rule.

CMS Issues E-Prescribing Final Rule: Quick Takeaways in a No-Slowing-Down Reg Cycle – Regulatory Talk Series

On June 13, 2024, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) issued a final rule revising standards for electronic prescribing, prior authorization, and real-time benefits under Medicare Part D.

Some top takeaways:
-  
Formulary and benefit version 60 is required by January 1, 2027
-  Real-Time Prescription Benefit version 13 is required by January 1, 2027
-  All e-prescribing routing transactions are required to use NCPDP SCRIPT version 2023011 by January 1, 2028
-  Electronic Prior Authorization is upgraded to NCPDP SCRIPT 2023011 by January 1, 2028
-  Medication History is upgraded to NCPDP SCRIPT 2023011 by January 1, 2028

View the full details here.

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Topics: E-Prescribing | Price Transparency

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Topics: HTI-2 Compliance | ONC | ASTP

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Topics: Specialty Medication | Prior Authorization

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Topics: Prior Authorization

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The new final rule issued by CMS on June 13, 2024, goes beyond a basic upgrade of SCRIPT standards and improves care connections between doctors, pharmacies, and patients.

Topic: The Centers for Medicare & Medicaid Services (CMS)

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Topic: The Centers for Medicare & Medicaid Services (CMS)

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Topic: The Centers for Medicare & Medicaid Services (CMS)

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What’s Needed for EPCS: Critical Requirements for Providers and Vendors
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Topics: E-Prescribing | Medication Management

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Topics: The Office of the National Coordinator (ONC) | The Centers for Medicare & Medicaid Services (CMS)

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Topic: The Office of the National Coordinator (ONC)

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Federal EPCS Requirement

As of January 1, 2023, The Centers for Medicare & Medicaid Services (CMS) requires all controlled substance prescriptions under Medicare’s Part D drug plan to be transmitted electronically. Additionally, the new compliance date for electronic prescriptions in Long Term Care facilities is January 1, 2025.

Click the map below to discover EPCS & PDMP compliance state requirements.

Federal EPCS Requirement State Map

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