HHSFinal Rule
Administrative Simplification: Modifications of Health Insurance Portability and Accountability Act, National Council for Prescription Drug Programs Retail Pharmacy Standards; and Modification of the Medicaid Pharmacy Subrogation Standard
HealthcareFinance & Banking
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Summary
This federal rule updates how health insurance companies and pharmacies handle prescription drug information and payments to simplify the process and reduce paperwork burdens. The changes aim to make it easier for insurance companies, pharmacies, and patients to manage prescription drug claims and ensure accurate billing when insurance covers medication costs.
Key Points
- 1Updates technology standards that pharmacies and insurance companies use to share prescription drug information electronically
- 2Simplifies how Medicaid (government health insurance for low-income people) recovers costs when it has already paid for medications that other insurance should have covered
- 3Reduces administrative paperwork and processing time for healthcare providers and insurance companies
- 4Affects pharmacies, health insurance plans, and Medicaid programs across the country
- 5Part of a larger effort called 'Administrative Simplification' to cut unnecessary red tape in healthcare
Key Dates
Published
August 21, 2025
This summary is for informational purposes only. It may not capture all nuances of the regulation. Always refer to the official text for authoritative information.
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