New reforms under the HTI-4 Final Rule: Electronic Prescribing, Real-Time Prescription Benefit, and Electronic Prior Authorization have been finalized. Let’s take a closer look at what this change means for patients, providers, and practices and how it’s shaping the future of healthcare in the United States.
The U.S. Department of Health and Human Services (HHS) has taken a major step toward advancing interoperability and transparency in healthcare. New reforms under the Health Data, Technology, and Interoperability Final Rule: Electronic Prescribing, Real-Time Prescription Benefit, and Electronic Prior Authorization have been finalized.
Soon, patients will have greater access to information that lets them compare drug prices, view out-of-pocket costs, and see prior authorization requirements before a prescription is written or filled. For healthcare providers, the rule introduces new interoperability standards designed to streamline administrative workflows, enhance care coordination, and reduce delays in patient treatment. It is a pivotal shift toward connected, patient-centric care. Let’s take a closer look at what this change means for patients, providers, and practices and how it’s shaping the future of healthcare in the United States.
Key Provisions of the HTI-4 Rule
The HTI-4 rule was issued through the HHS Office of the National Coordinator for Health Information Technology (ONC). Its goal is to make prescription data more transparent and accessible. The rule ensures that healthcare providers using certified electronic health record (EHR) systems can:
- Electronically submit prior authorization requests.
- Select medications consistent with a patient’s insurance coverage.
- Share prescription data with pharmacies and insurance plans in real time.
These capabilities enable prescribers to make fully informed decisions during patient visits, eliminating the need for follow-up calls or manual verifications.
Closing the Gap on Prescription Cost Transparency
Prescription drug prices in the U.S. are often difficult to understand, leading to surprise costs at the pharmacy. The HTI-4 rule addresses that issue by integrating real-time prescription benefit (RTPB) tools into certified health IT. This integration gives prescribers visibility into the true cost of medications based on a patient’s given insurance coverage. This cost includes co-pays, deductible status, and potential generic alternatives.
This same information will be available to patients through portals and apps connected to their health records. This level of real-time transparency will help close information gaps that can lead to medication non-adherence. Note that, according to a survey by the Kaiser Family Foundation, three in 10 adults say they have not taken medicine as prescribed due to costs. In other words, because patients will be aware of their expected out-of-pocket costs in advance, they will be less likely to abandon prescriptions due to unexpected expenses.
Electronic Prior Authorization: Reducing Delays and Administrative Burden
Another key benefit of HTI-4 is the mandate for electronic prior authorization (ePA) capabilities within certified health IT systems. Practices complete an average of 39 prior authorization requests per physician, per week. This adds up to an average of 13 hours spent on completing these requests every week. Here are three benefits of the rule requiring all prior authorizations to be submitted and processed electronically through interoperable standards:
- Faster patient access to care through automated submission and response mechanisms
- Reduced administrative burden by limiting manual data entry and phone calls
- Better documentation through complete electronic audit trails
The result is a single, consistent process rather than a patchwork of proprietary systems.
How HTI-4 Strengthens the Interoperability Framework
HTI-4 aligns with prior interoperability efforts led by the Centers for Medicare & Medicaid Services (CMS), such as the CMS Interoperability and Patient Access Final Rule, which established standardized APIs to enable patients and providers to securely access and exchange electronic health information. It also builds on the foundational frameworks of the 21st Century Cures Act and the ONC’s Interoperability and Information Blocking Final Rule. These frameworks prohibited information blocking and mandated the use of standardized data exchange protocols.
The HTI-4 rule advances these initiatives by embedding interoperability directly into prescribing and prior authorization workflows—the everyday processes that most directly affect patient access to medication.
Preparing Your Practice for HTI-4 Compliance
Practices must ensure that their EHR systems are certified and compliant with the HTI-4 requirements. Here are some deadlines to be aware of:
- October 1, 2025: The HTI-4 final rule became effective.
- Throughout 2027: Providers must attest to using a Prior Authorization API. The measure will not be scored in 2027.
- December 31, 2027: The transition period for healthIT developers to adopt the new NCPDP SCRIPT standard ends.
- January 1, 2028: The new NCPDP SCRIPT standard (2023011) becomes mandatory for certification.
Adopting certified EHR and E-Prescribing systems will be essential to remain compliant and fully benefit from the rule’s capabilities. It is to the benefit of providers to take a proactive approach to improve operational efficiency and patient satisfaction. These two outcomes are increasingly tied to reimbursement and value-based care metrics.
RXNT’s E-Prescribing and Practice Management solutions are already aligned with current interoperability standards, and will provide HTI-4 compliance as mandates approach. Our solutions include integrated tools for ePA, real-time benefit checks, and secure data exchange. Discover how RXNT can enable you to deliver better care with less administrative effort.
