HHS Delays New Pharmacy HIPAA Standards Until April 2025
Published Date: 2/11/2025
Rule
Summary
The government is pushing back the start date for new pharmacy rules that update how electronic health info is shared, now effective April 14, 2025. These changes affect pharmacies, health plans, and Medicaid by improving how claims, eligibility, referrals, and benefits are handled electronically. Everyone has more time to get ready, with full compliance due by April 14, 2028, so no rush and no extra costs right now!
Analyzed Economic Effects
3 provisions identified: 2 benefits, 1 costs, 0 mixed.
Compliance Deadline Extended to April 14, 2028
Full compliance with the updated retail pharmacy and Medicaid pharmacy subrogation standards is extended to April 14, 2028. Affected entities have until that date to implement the required electronic transactions.
Start Date Delayed to April 14, 2025
The rule that updates pharmacy electronic transaction standards (claims, eligibility, referral certification and authorization, coordination of benefits, and the Medicaid pharmacy subrogation transaction) will not take effect until April 14, 2025. The incorporation by reference of certain publications adopted in that rule is also delayed to April 14, 2025.
Correction: Transition Period Date Moved to June 11, 2027
A technical correction noted that references in the December 13, 2024 rule to August 11, 2027 should instead read June 11, 2027 for the 8-month transition period prior to full compliance. The delay to April 14, 2025 permits time to publish that correction.
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