Available Until 12/31/2023

Change is Coming in Prior Authorization & Price Cost Transparency: Regulations, Standards & Adoption

Course Description:

Health care is experiencing a resurgence in industry drive and will to automate prior authorization (PA) and improve cost transparency for patients and providers. Standards, whether NCPDP SCRIPT, X12N, or HL7 FHIR, are just a part of the potential tools being used to meet these established and expected requirements. The industry has the opportunity to solve real challenges above and beyond automating existing blockers.

This session will provide an overview of CMS’ goals and vision, showcase real-world examples of what stakeholders across the continuum are doing to transform PA, and elaborate on the transparency of cost and affordability. Most importantly, this session will highlight how pharmacists can join the discussion to lend their voice and define their role in this business transformation to ensure they solve the challenges, reduce patient time to therapy, improve medication adherence, and automate PA, adding clarity to coverage, cost, and services available to help patients be adherent.

Learning Objectives:

At the completion of this activity, participants should be able to:
  1. Summarize the relationship between NCPDP and emerging HL7 FHIR standards.
  2. Identify key drivers for innovation in prior authorization and price transparency towards automation.
  3. Describe ways that automation and standards can streamline existing specialty prescribing steps.
  4. Describe how pharmacists can help progress prior authorization and price transparency.


Kim Boyd

Sr Consultant, Regulatory Resource Center Lead

Point-of-Care Partners

Murfreesboro, TN

Alexandra Mugge, MPH

Director, and Deputy Chief Health Informatics Officer

Centers for Medicare & Medicaid Services

Baltimore, MD


Tzuyin Kuo, PharmD

PharmD Fellow

University at Buffalo-NYS Department of Health

Buffalo, New York


The Academy of Managed Care Pharmacy (AMCP) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

ACPE UAN:0233-0000-22-052-H04-P  • Activity Type: Knowledge-Based
Contact Hours: 1.25
Release Date: October 12, 2022 •  Expiration Date: December 31, 2023
Activity Fee: Free for Members and $30 for Non-Members

Participants should claim continuing pharmacy education (CPE) credit for this home study activity only if they have not claimed credit for the live activity presented at Nexus 2022. CPE credit will be processed through the AMCP Learn portal and reported directly to CPE Monitor. Please allow 72 hours for processing and posting in your NABP account.

To receive credit for an online activity you must:

  • Review the full content of the activity.
  • Successfully complete the post-test (required to pass with a score of 70% or higher, it may be taken a maximum of three times).
  • Complete a specific activity evaluation.

System Technical Requirements/Viewing Requirements:

System Requirements Courses and learning activities are delivered via your Web browser and Acrobat PDF. For all activities, you should have a basic comfort level using a computer and navigating websites. View the minimum technical and system requirements for continuing education online learning activities.

Credit Information

Activity Number Credit Amount Accreditation Period
ACPE UAN #0233-0000-22-052-H04-P 1.25 Contact Hours October 12, 2022 - December 31, 2023