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In recent years, federal agencies have accelerated efforts to modernize how medications are prescribed, with a clear emphasis on transparency, interoperability, and patient access. What was once a fragmented, opaque process is steadily evolving into a more data-driven and coordinated experience—largely due to regulatory action from the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC).
Two capabilities at the center of this transformation are Real-Time Prescription Benefit (RTPB) tools and electronic Prior Authorization (ePA). While these technologies are often discussed in terms of efficiency, their growing adoption is deeply rooted in federal policy.
A major turning point came in May 2019, when CMS finalized the Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses rule. This regulation introduced new requirements aimed at increasing drug pricing transparency and reducing cost-related barriers to care.
One of the most impactful provisions required Medicare Part D plan sponsors to implement at least one electronic real-time benefit tool (RTBT) by January 1, 2021. These tools must be capable of integrating directly with prescribers’ electronic prescribing (eRx) systems or electronic health records (EHRs).
The goal was to ensure that, at the point of care, clinicians could access:
This marked a significant shift away from retrospective problem-solving—where issues are addressed after a prescription is written—toward proactive, informed decision-making during the prescribing process.
Building on this momentum, CMS and ONC finalized additional policies in May 2020 under the 21st Century Cures Act. While much of the Cures Act is known for addressing interoperability and information blocking, it also reinforced the importance of improving access to actionable clinical data—including prescription benefit information.
The Cures Act framework emphasizes that health IT systems should not only exchange data, but do so in a way that meaningfully supports clinical workflows. RTPB fits squarely within this vision by delivering relevant cost and coverage data at the exact moment it is needed.
As these regulatory requirements take hold, standards development organizations have played a key role in shaping how RTPB is implemented. The National Council for Prescription Drug Programs (NCPDP) has developed standards specifically designed to support real-time prescription benefit transactions.
ONC continues to monitor the adoption and maturity of these standards and has indicated that it may propose formal adoption of the NCPDP RTPB standard—or a similar framework—in future rulemaking. This signals that RTPB is not just a short-term compliance requirement, but an evolving capability likely to become more standardized across the industry.
Alongside RTPB, electronic Prior Authorization (ePA) has emerged as another focus area for regulators. Prior authorization has historically introduced delays and administrative complexity, often relying on manual processes such as phone calls, faxes, and paper forms.
As regulatory expectations continue to evolve, healthcare organizations are increasingly expected to adopt technologies that align with these standards. This transition can be complex, requiring solutions that not only meet compliance requirements but also integrate seamlessly into clinical workflows.
MEDHOST now offers RTPB and ePA capabilities designed to support this shift. By enabling access to real-time benefit data and streamlining prior authorization processes, these solutions help providers align with current regulations while reducing administrative burden and improving the overall prescribing experience.
To learn more about how MEDHOST partnerships support connected care, contact us at (800) 383-6278 or email inquiries@medhost.com.
