Insurers have eliminated 11% of prior authorizations under reform pledge
By Paige Minemyer / April 7, 2026
Last summer, the insurance industry broadly agreed to reform a major healthcare pain point: prior authorization.
Now, two of the industry's leading organizations are offering a look at progress toward those goals. AHIP and the Blue Cross Blue Shield Association released a report on Tuesday that found leading health plans reduced prior authorizations for an array of services by 11% since the pledge was made.
This equates to 6.5 million fewer prior auth requests for patients, according to the report. Reductions in Medicare Advantage specifically were 15%, it reads.
“Health plans have taken important initial steps to support patients and are working toward the shared goal of delivering answers at the point of care whenever possible—a goal that will require both plans and providers to eliminate manual processes and adopt real-time electronic data sharing,” said Mike Tuffin, AHIP President and CEO, in the announcement.
Services that are no longer subject to prior authorization include those with clear clinical guidelines and consistent utilization trends for providers, per the announcement. The insurers have also worked to use more consumer-friendly language in determinations, and if an authorization is denied, make it clear what an appeal or next step could be.
As part of the June 2025 pledge, insurers said they would demonstrate notable progress toward the goals by the beginning of 2026. About 50 plans signed on to the initiative, including all six of the largest, publicly traded insurance conglomerates: Elevance Health, Centene, Cigna, CVS Health's Aetna, Humana and UnitedHealthcare.
Key changes included reducing the number of services subject to prior authorization, as well as implementing solutions to promote electronic prior auth, with plans to establish a framework for both payers and providers by Jan. 1, 2027.
Officials at the Centers for Medicare & Medicaid Services and the Department of Health and Human Services also played a major role in establishing the reforms. Prior auth remains a significant frustration for both patients and providers, with many patients citing it as the largest navigation challenge they face, according to a recent KFF poll.
The insurance groups said that the changes on tap for the rest of the year will support a faster, more streamlined experience for prior auth, and establish critical industry standards.
Kim Keck, CEO of BCBSA, said in the announcement that the Blues network will continue to focus on its commitment to manage 80% of electronic prior auth submissions in real-time as they move forward with the reform initiative.
The reductions already seen have helped to reduce administrative burdens and accelerate access to care, per the announcement.
"We share CMS' urgency to modernize the infrastructure of health care and understand that all of us—policymakers, payers and care providers—have a role to play in activating change," Keck said.
Providers, meanwhile, took a “wait and see” approach to insurers’ promises, expressing faint praise to the pledge without seeing if the initiative would bear real fruit. And while a recent analysis from Kodiak Solutions finds that providers were paid more quickly last year, they did miss out on significant revenue amid a rise in clinical claims denial activity.