Last week, we hosted a webinar exploring the proposed CMS “Interoperability Standards and Prior Authorization for Drugs” rule (CMS-0062-P) and its potential impact on payers, providers, PBMs, pharmacies, health IT vendors, and industry collaboratives. The session brought together perspectives from POCP experts, HL7 Da Vinci Project leadership, and NCPDP to unpack both the policy and operational implications of the proposal.

The webinar was half presentation, half panel discussion, which featured:

• Mary Griskewicz, Sr. Consultant and Policy Expert, POCP
• Alix Goss, Sr. Consultant, POCP & Program Manager, HL7 Da Vinci Project
• Vanessa Candelora, PP&T Management & Operations Lead, POCP
• Kendra Obrist, Sr. Consultant & Payer Interoperability Expert, POCP
• Brian Dwyer, Business Strategy Lead, POCP
• Pooja Babbrah, EVP, Strategy & Industry Alignment, NCPDP

The conversation made one thing clear: CMS-0062-P is not simply another compliance exercise. It signals a broader push toward a more connected, transparent, and interoperable ecosystem where medical and pharmacy workflows can no longer operate in separate universes.

For those who could not attend live, the webinar recording and slides are now available. We encourage stakeholders to watch the full session and review the presentation deck for a deeper dive into the proposed rule, timelines, standards, and strategic considerations.

CMS Is Trying to Connect the Last Major Interoperability Gap

A major theme throughout the discussion was that CMS-0062-P builds directly on CMS-0057 but extends interoperability requirements into pharmacy workflows and drug prior authorization.

Panelists emphasized that the proposal is designed to create a more unified framework across medical and pharmacy benefits, reducing fragmentation and administrative friction.

Historically, medical benefit prior authorization and pharmacy benefit prior authorization have relied on different standards, systems, and operational models. CMS is now attempting to align those worlds under shared expectations for transparency, automation, and timeliness.

As several panelists noted, this matters because patients do not experience their care in silos. Oncology was highlighted as an example where treatments, supportive medications, and diagnostics may span both medical and pharmacy benefits, creating operational complexity and delays that providers and patients must navigate manually today.

The Rule Is About More Than Faster Prior Authorization

One of the more interesting discussions centered on how the industry should think about “speed” in the context of prior authorization.

HL7 Da Vinci Project Program Manager Alix Goss explained that the goal is not simply to generate faster denials. Instead, the vision is to determine earlier in the workflow whether prior authorization is even required and to automate the retrieval of supporting documentation when it is needed.

That shift has significant implications for workflows inside EHRs, payer systems, and pharmacy systems. The proposed rule reinforces the use of standards and APIs intended to support more prospective, real-time decision making rather than reactive back-and-forth exchanges driven by fax machines, phone calls, and manual follow-up.

Panelists repeatedly stressed that interoperability is only part of the equation. Operational workflows, staff adoption, transparency, and trust between ecosystem participants will determine whether these processes actually become more efficient in practice.

Existing Investments Matter More Than Organizations May Realize

Another key takeaway was that many organizations are not starting from zero.

POCP’s payer experts noted that many payers are already preparing for CMS-0057, anticipated that drugs would eventually be incorporated into interoperability requirements, and have been planning accordingly.

Likewise, NCPDP emphasized that many of the pharmacy standards referenced in the proposed rule already exist and have been implemented for years. The shift now is that workflows and transactions that were previously optional may become mandatory.

That distinction is important for stakeholders assessing readiness. Existing API investments, payer interoperability programs, and prior authorization modernization efforts may provide a stronger foundation for CMS-0062-P compliance than some organizations initially assume.

At the same time, panelists cautioned that being technically compliant does not necessarily mean systems will immediately be useful, scalable, or operationally mature. Several speakers compared the current moment to the early evolution of electronic claims processing, noting that true interoperability maturity will likely require years of refinement and operational learning.

The Industry Should Pay Attention to the Standards Strategy

The webinar also explored one of the proposal’s most consequential technical shifts: CMS proposing to retire the legacy X12 278 transaction in favor of FHIR-based prior authorization workflows.

Panelists described this as a major signal about where the federal interoperability strategy is heading. The proposed rule formally incorporates multiple HL7 Da Vinci implementation guides for medical benefit workflows while also relying on NCPDP standards for pharmacy benefit workflows.

The discussion reinforced that CMS is not attempting to force a single standard across every workflow. Instead, the strategy appears focused on enabling different standards organizations and frameworks to work together in support of more connected experiences.

The panel also highlighted the growing importance of infrastructure work happening through initiatives such as FAST, particularly around endpoint discovery, directories, and scalable exchange frameworks.

Organizations Should Be Thinking Beyond Compliance

Perhaps the most consistent message throughout the webinar was that organizations should avoid viewing CMS-0062-P as simply another regulatory deadline.

The proposed rule creates opportunities to rethink workflows, improve patient experiences, reduce administrative waste, and better connect clinical and pharmacy data. But achieving those outcomes will require organizations to think strategically about interoperability, operational change management and long-term infrastructure modernization.

Stakeholders also still have an opportunity to influence the final rule through comments to CMS, which are due June 15, 2026.

Need Help Navigating CMS-0062-P?

POCP works with stakeholders across the healthcare ecosystem because a change or requirement for one stakeholder group will inevitably impact another stakeholder group or part of the ecosystem. We understand the practical and strategic implications of emerging interoperability policy and how dots connect.

Whether your organization needs help:

• crafting and refining comment letters to CMS
• understanding how CMS-0062-P may impact your operations,
• evaluating readiness based on CMS-0057 work already underway,
• or, developing implementation strategies to work ahead of finalization.

Our team can help. Contact us to set up a time to chat.