Insurers pledge ease to prior authorizations
By Jakob Emerson / June 24, 2025
The broader health insurance industry has announced a series of commitments to streamline, simplify and reduce prior authorization requirements across commercial, Medicare Advantage and managed Medicaid plans covering 257 million Americans.
“The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike,” AHIP President and CEO Mike Tuffin said June 23. “Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system.”
Seven things to know:
1. The nearly 50 participating insurers will work to implement a standardized submission process for electronic prior authorizations, with the goal to be operational and available to plans and providers by January 1, 2027. The industry is aiming for at least 80% of electronic prior authorization approvals to be provided in real-time in 2027.
2. Individual plans will commit to specific reductions to prior authorizations, with reductions rolling out by January 1, 2026.
3. Beginning January 1, 2026, when a patient changes insurance companies during a course of medical treatment, the new plan will honor existing prior authorizations for benefit-equivalent in-network services as part of a 90-day transition period.
4. Insurers will also provide clear explanations of prior authorization decisions, including support for appeals and guidance on next steps, which is expected to be operational for fully insured and commercial coverage by January 1, 2026.
5. Prior authorization reform has been a top-of-mind issue for health systems and physicians for years. A recent survey conducted by the American Medical Association found that nearly 90% of physicians reported that the process somewhat or significantly increases burnout. Physicians and their staff spend 13 hours each week on prior authorizations and 40% have staff who work exclusively on the process.
6. In recent years, major insurers like UnitedHealthcare and Cigna have cut more than 20% of the procedures requiring prior authorization. The AMA said, however, that “most physicians are not seeing a difference.”
7. In January 2024, CMS finalized a rule to streamline the prior authorization process. Beginning primarily in 2026, certain payers will be required to include a specific reason when denying requests, publicly report certain prior authorization metrics and send decisions within 72 hours for urgent requests and seven calendar days for standard requests.
Industry Reactions:
CMS Administrator Mehmet Oz, MD
“These commitments represent a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care. We applaud these voluntary actions by the private sector, which is how these types of issues should be solved. CMS will be evaluating progress and driving accountability toward our shared goals, as we continue to champion solutions that put patients first.”
AMA President Bobby Mukkamala, MD
“We are pleased with the industry’s recognition that the current system is not working for patients, physicians or plans. However, patients and physicians will need specifics demonstrating that the latest insurer pledge will yield substantive actions to bring immediate and meaningful changes, break down unnecessary roadblocks, and keep medical decisions between patients and physicians. The AMA will closely monitor the implementation and impact of these changes as we continue to work with federal and state policymakers on legislative and regulatory solutions to reduce waste, improve efficiency, and, most importantly, protect patients from obstacles to medically necessary care.”
Medical Group Management Association’s Senior Vice President of Government Affairs Anders Gilberg
“While we are encouraged by today’s announcement from health plans on prior authorization, much of what insurers intend to do has already been mandated by CMS for their Medicare Advantage and Medicaid managed care plans along with similar adoption dates. It makes sense for them to implement changes across commercial products as well. MGMA joined a consensus statement with provider groups and health plans in 2018 that had similar agreed-upon principles for improving prior authorization, yet year-after-year we continue to hear from physician practices that it is their number one administrative burden. Seven years after the consensus statement and several CMS final rules later, health insurers appear to finally be taking steps toward implementation. We look forward to receiving more details about the initiative and working towards reducing the overall volume and burden of prior authorization requirements.”
Better Medicare Alliance President and CEO Mary Beth Donahue
“Prior authorization helps keep costs down and ensures patients get the best care, but it should be easier. These commitments will make a positive difference — reducing unnecessary delays and denials for millions of Americans, including seniors enrolled in Medicare Advantage. We applaud this step and remain committed to engaging policymakers around this important issue.”