HTI-4 Standards Target Lack of Transparency in Medication Access

The Health Data, Technology, and Interoperability (HTI-4) Final Rule aims to strengthen the nation’s health IT ecosystem by advancing electronic prescribing capabilities, improving drug price transparency, and accelerating approvals for needed medications through streamlined prior authorization.

HTI-4 introduces updated certification criteria and new data standards that will require electronic health record (EHR) and e-prescribing systems to support real-time prescription benefit checks, allowing prescribers to compare medication costs, formulary status, and patient-specific coverage options at the point of care. This effort is expected to reduce patient cost surprises and improve access and adherence.

Another key focus of HTI-4 is the adoption of enhanced electronic prior authorization (ePA) functionality. By automating data exchange between prescribers and payers, the rule intends to ease administrative burden, speed treatment decisions, and reduce delays that negatively impact patient health outcomes.

Although HTI-4 became official on Oct. 1, 2025, as noted by Colin Banas, MD, DrFirst’s chief medical officer in a video interview with Pharma Commerce, stakeholders should understand that this marks the rule’s formal enactment, not the deadline for compliance. The implementation timeline extends several years: 2027 for real-time benefit requirements and 2028 for the new e-prescribing standards. As Banas explains, many of the rule’s components have been in development since earlier HTI regulations, and portions of the required functionality are already present in today’s leading EHR and prescribing platforms.

Overall, HTI-4 reinforces the ongoing national push toward interoperability and patient-centric prescribing. By advancing technology that supports faster, more informed medication decisions, the rule aims to drive better outcomes, reduce administrative friction, and strengthen transparency across the medication access process.

He also shares how real-time prescription benefit tools and electronic prior authorizations affect the daily workflow of HCPs; the kinds of challenges providers and health systems may face during the transition period; and much more.

A transcript of his conversation with PC can be found below.

PC: How could these new standards improve access to medications and overall care?

Banas: The whole process suffers from a transparency problem, and it's transparency on all fronts. The providers often don't know when we're writing the script. The patients don't know even when they go to pick it up, etc. I'm fond of saying, you and I have more visibility into the Domino's Pizza order than we do to a life-saving medication.

I can see that it was ordered. I can see that it's in the oven. I can see that the driver is waiting to pick it up. It's wild, right? That’s what patients need, and quite frankly, that's what the providers need to. Where are we in the process? What do you need me to do? What do you need from the patient, and make it actionable—back to my earlier comment about good support is actionable support.

It's an exciting time, because there's a lot of pressure. I think patients and providers are a lot more literate in the insurance world, in the prescribing process, and the prior authorizations. In the old days, it was sort of out of sight, out of mind, someone else is dealing with that. Who's left holding the bag is the patient. They're not getting the medications they need, so people are frustrated. People started to educate themselves and demand this transparency, and that's why you've seen these rules picking up speed.

HTI-4 came pretty quickly after HTI-2. I mean, I think it was like a year ago. We were talking about all the things that were in 2, and we've already made 4 final in just a couple days. Same thing, you've seen insurers and tech companies making these pledges to promote interoperability and to promote a more seamless patient experience. Obviously, the pressure is getting to the right places. When we apply pressure, it might be uncomfortable at first, but then we finally get the results that we need.