New HTI-4 Final Rule Sets Path for Modernized Prescribing and Patient Access

The Health Data, Technology, and Interoperability (HTI-4) Final Rule aims to strengthen the nation’s health IT ecosystem by advancing electronic prescribing capabilities, improving drug price transparency, and accelerating approvals for needed medications through streamlined prior authorization.

HTI-4 introduces updated certification criteria and new data standards that will require electronic health record (EHR) and e-prescribing systems to support real-time prescription benefit checks, allowing prescribers to compare medication costs, formulary status, and patient-specific coverage options at the point of care. This effort is expected to reduce patient cost surprises and improve access and adherence.

Another key focus of HTI-4 is the adoption of enhanced electronic prior authorization (ePA) functionality. By automating data exchange between prescribers and payers, the rule intends to ease administrative burden, speed treatment decisions, and reduce delays that negatively impact patient health outcomes.

Although HTI-4 became official on Oct. 1, 2025, as noted by Colin Banas, MD, DrFirst’s chief medical officer in a video interview with Pharma Commerce, stakeholders should understand that this marks the rule’s formal enactment, not the deadline for compliance. The implementation timeline extends several years: 2027 for real-time benefit requirements and 2028 for the new e-prescribing standards. As Banas explains, many of the rule’s components have been in development since earlier HTI regulations, and portions of the required functionality are already present in today’s leading EHR and prescribing platforms.

Overall, HTI-4 reinforces the ongoing national push toward interoperability and patient-centric prescribing. By advancing technology that supports faster, more informed medication decisions, the rule aims to drive better outcomes, reduce administrative friction, and strengthen transparency across the medication access process.

He also shares how real-time prescription benefit tools and electronic prior authorizations affect the daily workflow of HCPs; the kinds of challenges providers and health systems may face during the transition period; and much more.

A transcript of his conversation with PC can be found below.

PC: With the HTI-4 rule becoming official on Oct. 1, what do you see as the most significant changes prescribers should be aware of?

Banas: Oct. 1 is when the rule is official. It doesn't actually mean that's when things change because if you look, the deadlines for things like real-time prescription benefit is still 2027 and the deadlines for the new e-prescribing standard is 2028. What happens on Oct. 1 is we can stop calling it a proposed rule and actually call it the rule.

That’s when it becomes more real, but what's interesting is the things that are being discussed in there—such as the price transparency, prior authorization, things like that—those are actually things that have been teed up for quite some time, going all the way back to HTI-1 or HTI-2.

Those things are being introduced and talked about. A lot of those things are already existent in EHRs or e-prescribing platforms already; it just makes it a little bit more real. It gets a little bit more momentum behind it, in my opinion.

This train was already rolling, which is a good thing.