Interoperability

HEALTH POLICY BRIEF — Thursday, October 1

CMS is testing an alternative Part B drug-inflation-rebate calculation using international net-price benchmarks.

Matt Reid

— 2 min read
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Executive Briefing

CMS is testing an alternative Part B drug-inflation-rebate calculation using international net-price benchmarks. The GLOBE final rule (https://www.federalregister.gov/public-inspection/2026-20281/global-benchmark-for-efficient-drug-pricing-model) (public inspection September 30; publication October 2) mandates manufacturer participation for selected drugs. The model starts January 1, 2027, with performance April 1, 2027–March 31, 2032, for about 25% of eligible Original Medicare Part B beneficiaries. CMS estimates $440 million in net Part B savings—useful test data. Physician policy angle: practices remain nonparticipants and keep buying and billing normally. Prepare: monitor CMS’s ZIP-code regions and quarterly HCPCS/coinsurance list; test practice estimates while CMS expects ordinary claims processing to handle payment.

ONC’s burden evidence is a pointed split-screen: among 8,400-plus family physicians, substantial after-hours documentation fell from 41% to 34% between 2024 and 2026 and external-information burden fell from 43% to 38%, but prior-authorization burden rose from 54% to 58%. Only 13% often received medication data that were simultaneously automatic, findable, and usable. ONC, “Less Pajama Time, More Patient Time,” September 30 (https://healthit.gov/blog/interoperability/less-pajama-time-more-patient-time-how-better-interoperability-can-reduce-physician-burden/). Policy relevance: connectivity alone is insufficient; data must be available, findable, usable, and integrated into workflow. Act: use these findings in the next prior-authorization engagement.

CMS’s 2027 MA and Part D landscape (https://www.cms.gov/newsroom/press-releases/medicare-advantage-medicare-prescription-drug-programs-expected-remain-stable-2027) (September 30) projects average MA premiums down 16.5% to $12, national plan availability nearly flat, and stand-alone Part D premiums up less than $1 to $36. Smooth averages do not prove equally smooth networks, benefits, utilization management, or county access. Monitor: compare plan-level files before open enrollment begins October 15.

Digital Health / Interoperability / Prior Authorization

ONC’s pre-compliance baseline for real-time prescription benefits found broad availability at 55% of hospitals, versus 48% of small, 46% of rural, 40% of independent, and 21% using smaller EHR developers. The Base EHR requirement arrives January 1, 2028. ONC data brief, September 30 (https://healthit.gov/data/data-briefs/availability-of-real-time-prescription-benefit-information-among-u-s-hospitals/). Prepare: press for implementation help, accurate payer data, and testing that does not leave low-leverage providers holding the bag.

Standards / Coding / Data Infrastructure

ONC launched Cartos (https://healthit.gov/standards-and-technology/cartos/), a public browser and read-only FHIR R4 terminology API for implementation, testing, and certification readiness. ONC preserves each steward’s licensing rules and warns that some content may be limited or metadata-only. Monitor: test coverage, provenance, rate limits, and licensed-content gaps.

Policy Action Implications

Prioritize GLOBE implementation files, ONC’s prior-authorization evidence, MA plan-level access before October 15, and small-provider RTPB/Cartos readiness.

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