Price Transparency Advances, Prior Authorization Still Stalls

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 might real-time prescription benefit tools and electronic prior authorizations affect the daily workflow of HCPs?

Banas: In reality, the real-time prescription benefit is a tool most prescribers already have access to. Whether or not all of the payers that their patient panel is using for insurance purposes—if their info is in there—is a different question. But I think by this time, most prescribers are used to this concept of being able to see if it's covered, what the copay will be. Are there alternatives? Not all prescribers trust that data, which is another problem we could talk about, but at least the tool has been around for a good seven to 10 years.

In fact, DrFirst was one of the first pioneers in real-time prescription benefit, which is actually a pretty cool thing that we get to claim. I think prescribers are used to it. I think it could be a little bit better in terms of how the data is presented. Where in workflow do I get to see this? Is that data actionable? Every good decision support is not just a pop-up—I actually have to be able to do something with it. I have to be able to change the prescription or change where I'm sending it, or change the amount, or things like, if you just pop something up, it's actually annoying, so it needs to be actionable.

Now the prior authorization question is much more top of mind for most of us right now, because, let's face it, most of the prior authorizations we are doing are still phone calls and faxes, and sort of this endless ping-pong of like, wait and see, get the fax back. You forgot to check this box, or you forgot to include this information.

The fact that we're finally moving towards a recognized standard on the electronic front is good. It is certainly something that is long overdue. And every good revolution in healthcare starts with a good framework. I do think the framework is finally there. The standards have finally been defined. We’re laying the rails now, let's get the train moving, but we still have a really long way to go. I think if you describe them, I'd say the price transparency is almost there. Some little tweaks and we can make it better, but the prior authorization, we're laying the tracks. We're laying the found the foundation, so that we can eventually get that train moving.