New CMS prior authorization timelines highlight major infrastructure gaps while underscoring the link between access, affordability, and medication adherence.
In an interview with Pharmacy Times, Joseph Kleiman, president of Buzz Health, discussed the readiness of current e-prescribing infrastructure to meet new proposed Centers for Medicare & Medicaid Services (CMS) mandates requiring 24-hour and 72-hour prior authorization timelines and real-time, Fast Healthcare Interoperability Resources (FHIR)–based workflows. Kleiman emphasized that the industry is not prepared, citing fragmented systems, reliance on outdated processes such as fax and phone calls, and lack of standardized, automated data exchange. He highlighted that gaps in interoperability, consistency, and real-time information sharing continue to slow prior authorization workflows.1
From a clinical perspective, Kleiman explained that reducing these friction points could significantly improve patient access, as delays and uncertainty around coverage and cost often lead to treatment abandonment or nonadherence. He noted that affordability and prior authorization are closely linked, referencing research showing 76% of prescribers identify medication cost as a key barrier, with unclear pricing and access pathways contributing to delays in care.2
Kleiman stressed that achieving CMS goals will require honest assessment of system readiness, investment in infrastructure, and collaboration across stakeholders to standardize workflows. Ultimately, he underscored that improving the operational side of prescribing—through better technology and streamlined processes—will lead to more consistent access, improved adherence, and better patient outcomes.
Pharmacy Times: Can you please introduce yourself?
Joseph Kleiman: I’m Joseph Kleiman. I am the president of Buzz Health. We’ve really, over the last few years, started to focus a lot more on the operations and the technology behind prescriptions and e-prescribing and the workflows, and we’re really trying to improve all that to make it easier for consumers. I figure if we do our job well, eventual adoption will ultimately result in a better experience for consumers.
Pharmacy Times: CMS is proposing 24-hour and 72-hour turnaround requirements for prior authorization. Based on what you’re seeing today, can current infrastructure realistically meet those timelines?
Kleiman: You know what? Not yet. I think that you have some electronic health records that are a little bit more capable than others or a little bit closer to doing that, but the industry and the systems in general are still very fragmented. You still have some systems running on HL7 [Health Level Seven], and they’re faxing and they’re calling. Until everybody gets up to speed and decides to invest in their own infrastructure, it won’t be completely ready.
Pharmacy Times: The rule emphasizes real-time, FHIR-based electronic workflows. What are the biggest gaps between today’s e-prescribing systems and what CMS is expecting?
Kleiman: I think the biggest gaps you’re going to have in this are you still have, when a request goes in for prior authorization, people that they call to check. It’s not very streamlined. There’s not a lot of automation where things just happen, and I think a lot of that comes from everybody operating on the same data sets, having information that’s readily available, making sure it’s concise, making sure it’s consistent, and making sure there’s no variation between platforms.
Pharmacy Times: From the prescriber and pharmacist perspective, how would faster prior authorization decisions change workflow and patient access at the point of care?
Kleiman: It’s crazy. A lot of people don’t really relate prior authorization and getting better with better patient access, but you’ve got to remember, whether it’s insurance or whether people are paying cash for their medications, it’s about friction points. And anytime there’s a friction point between your health care professional or your provider prescribing medication and when the patient knows what they’re going to pay, if anything, and how they’re going to get it, there’s an opportunity for bleed or slippage. Anytime something can be consistent, whether it’s pricing visibility that’s real time or whether it’s prior authorization so they know exactly the path they have to take, when that happens quickly and accurately, I think it bleeds into adherence, and I think it bleeds into better pricing. I think everything feeds off of each other.
Pharmacy Times: Your research findings show that 76% of prescribers cite medication costs as a barrier. How does prior authorization reform intersect with affordability and treatment delays in real-world practice?
Kleiman: It’s kind of what I was just talking about. When you look at it, people say, well, prior authorization doesn’t really have anything to do with cost, or it doesn’t have anything to do with adherence. But one thing definitely affects the other. If you don’t know what you’re going to pay, you don’t know sometimes how you’re going to pay for it. And if you don’t know how you’re going to pay for it or how much it is, you don’t know if you can, and you end up not taking your medication, or it takes you longer. You go off plan, you go off what you’re supposed to be doing. Every piece—I think people are starting to realize this, and systems are starting to realize this—is that they have to tie together. Everything needs to be consistent, because every path really affects the other one.
Pharmacy Times: As stakeholders at AXS26 discuss implementation, what should pharmacists and health systems be prioritizing now to prepare for these changes?
Kleiman: I think it’s really in 3 steps. The first thing is there’s got to be some honesty about who’s ready and who isn’t. You’ve got to evaluate where you’re at. The second part of that is you’ve got to be willing to invest in your systems. You’ve got to be able to talk to your technology providers and find out what you need to do collectively or to be part of something that is more consistent. How do you all get together? Listen to them. And the last part of it, you’ve got to be willing. You’ve got to be willing to invest. It’s important. You’ve got to acknowledge what’s out there, and you’ve got to be willing to invest. It doesn’t always have to be money—it could be time as well. You’ve got to be willing to do all 3.
Pharmacy Times: Is there anything else that you would like to add?
Kleiman: I think what you’re talking about and what the industry is talking about is really important. Buzz Health, a few years ago, we decided that it was really important to spend just as much time on the other side of the coin as getting medications to consumers directly through BuzzRx and working on systems. Because I do believe, and we believe at Buzz Health, that if you provide better systems and you make things easier and you make them affordable on the business side, it’ll ultimately result in better experiences and better outcomes for consumers.
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