This October marks the start of a new chapter in healthcare. Beginning October 1, 2025, a final rule from HHS and CMS requires certified health IT systems to provide real-time prescription drug pricing, coverage details, and prior authorization information at the very moment a provider writes a prescription.

For patients, this change could be transformative. Think about the all-too-familiar experience of leaving a doctor’s office with a prescription, only to discover at the pharmacy that the medication isn’t covered, the co-pay is far higher than expected, or prior authorization is needed before you can even begin treatment. These obstacles delay care, frustrate patients, and increase the chances that prescriptions are never filled at all.

The new rule is designed to reduce those barriers by shining a light on the cost and coverage of medications up front. With the right technology in place, providers and patients will see, in real time, whether a medication is covered, what the out-of-pocket cost will be, and what alternatives are available. If a prior authorization is needed, it can be initiated electronically within the EHR instead of relying on endless faxes and phone calls.

Behind the scenes, this change is powered by established standards — like the NCPDP Real-Time Prescription Benefit transactions, updated SCRIPT messaging, and newer FHIR-based APIs for prior authorization. But the impact extends far beyond technical details. For prescribers, it means they can finally have honest, informed conversations with patients about treatment choices that align with both medical needs and financial realities. For patients, it means leaving the doctor’s office with clarity instead of confusion, and with a better chance of starting therapy right away.

Of course, as with any large-scale change, there will be challenges. Not all payers and PBMs will have the required connections ready on day one. Data accuracy will need to be closely monitored, as medication pricing can fluctuate and complex benefit rules often create discrepancies between estimates and final pharmacy costs. And EHR vendors will have to design interfaces that integrate this information seamlessly into clinical workflows, without adding friction for already-busy clinicians.

Yet despite these hurdles, the momentum is undeniable. This is part of a broader trend toward transparency, interoperability, and patient-centered care. It reflects a shift from reactive systems to proactive solutions — where technology doesn’t just process transactions, but actively improves outcomes.

For health systems and providers, now is the time to prepare: review your EHR vendor’s roadmap, coordinate with payers, and begin testing workflows. For payers and PBMs, it’s about ensuring the right endpoints are exposed and the data is reliable. And for patients, it’s about finally having a healthcare experience that puts their needs, and their realities, front and center.

Where MyCabinet Fits In

At MyCabinet, we believe this shift toward transparency and digital enablement is long overdue. Our platform already helps members take control of their health by making it simple to add medications, set reminders, and keep health records organized in one secure place. As real-time prescription benefit tools and electronic prior authorization become standard, MyCabinet is uniquely positioned to help health plans and providers extend these capabilities directly into patients’ hands.

The result? Fewer delays, fewer surprises at the pharmacy, and healthier outcomes at scale. By combining the promise of these new regulatory requirements with an intuitive, patient-friendly tool, we can turn compliance into real impact.

References and Authoritative Sources

  1. Centers for Medicare & Medicaid Services (CMS). “CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F).”
    • Description: The primary regulation outlining requirements for payers, including Part D sponsors, to implement APIs and RTBTs to improve patient access and streamline prior authorization.
    • Source: Available on the Federal Register and at CMS.gov.
  1. Office of the National Coordinator for Health Information Technology (ONC). “Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) Final Rule.”
    • Description: The corresponding regulation detailing the certification criteria for Health IT developers and EHRs, which provider systems in your network must adopt.
  1. National Council for Prescription Drug Programs (NCPDP).
    • Description: The standards development organization responsible for the SCRIPT standard for e-prescribing and the Real-Time Prescription Benefit (RTPB) standard your plan must support.
  1. Health Level Seven International (HL7®). “Fast Healthcare Interoperability Resources (FHIR®).”
    • Description: The organization and foundational standard for exchanging healthcare information electronically, which underpins the API requirements for electronic prior authorization that your plan must implement.