CQC and 221 advocates call on CMS to finalize reforms that reduce delays, increase transparency, and help patients access doctor-recommended care

WASHINGTON – Today, Consumers for Quality Care (CQC) submitted formal comments to the Centers for Medicare & Medicaid Services (CMS) in response to the agency’s proposed rule on interoperability standards and prior authorization for drugs, urging CMS to finalize and strengthen policies that make prior authorization faster, more transparent, and more accountable to patients.

CQC was joined by 211 patient advocates who submitted comments calling on CMS to ensure patients can access the care and medications their doctors recommend without unnecessary delays, denials, or red tape. As of today, 211 advocates have already submitted comments through CQC’s activation campaign.

The proposed rule comes as patients across the country continue to face harmful delays caused by prior authorization requirements. Too often, patients are forced to wait days, weeks, or even months for treatments their doctors have already prescribed, worsening health outcomes, increasing costs, and creating unnecessary stress for families already navigating serious health challenges.

“Patients should not have to fight through insurance red tape to get care their doctor has already recommended,” said Jim Manley, CQC Board Member and former senior advisor to Senators Edward Kennedy and Harry Reid. “CMS’s proposed rule is an important step toward a healthcare system that works better for patients. Faster decisions, clearer explanations for denials, stronger appeals processes, and greater transparency around step therapy will help ensure prior authorization supports appropriate care instead of standing in the way of it.”

In its comments, CQC urged CMS to finalize key patient protections, including:

• Requiring 24-hour decisions for all drug prior authorization requests
• Ensuring patients receive detailed justifications for every denial
• Establishing robust appeals processes so patients have a meaningful path to access care
• Implementing electronic prior authorization to support real-time information sharing between insurers and providers
• Increasing transparency around step therapy requirements
• Requiring insurers to honor prior step therapy when patients change insurance plans

CQC also emphasized that prior authorization requirements place a significant administrative burden on physicians and their staff, taking time away from patient care. When doctors are forced to spend hours navigating paperwork and insurance approvals, patients are left waiting for necessary medications, treatments, surgeries, and other care.

“Doctors, not insurance companies, know what care their patients need,” Manley added. “CMS has an opportunity to make meaningful reforms that put patients first by ensuring prior authorization is evidence-based, transparent, and timely.”