Dozens of health insurers have made a series of commitments to improve and reduce prior authorization, payer advocacy organization AHIP announced on Monday. The practice is often a point of contention with providers, who argue that it adds administrative burden and delays care.
In total, 53 insurers pledged to simplify prior authorization, including UnitedHealthcare, Aetna, Cigna, several Blues plans and numerous regional insurers. The payers offer commercial coverage, Medicare Advantage and Medicaid managed care.
“The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike. 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,” said Mike Tuffin, president and CEO of AHIP, in a statement.
The insurers made commitments to six actions, according to AHIP:
Standardizing electronic prior authorization: The health plans will develop standardized data and submission requirements for electronic prior authorization to support faster turnaround times. They plan to achieve this by January 1, 2027.
Reducing the scope of claims subject to prior authorization: The insurers will reduce prior authorization requirements for certain claims, which will depend on the market each plan serves. These reductions are expected to start January 1, 2026.
Ensuring continuity of care when patients switch plans: When patients switch insurance plans during treatment, their new insurer must honor existing prior authorizations for similar in-network services for 90 days to ensure continuity of care and prevent delays. This will begin January 1, 2026.
Improving communication and transparency on determinations: The insurers pledge to give clear explanations of prior authorization determinations, as well as information on appeals. This will be available for fully insured and commercial coverage by January 1, 2026.
Expanding real-time responses: In 2027, the insurers anticipate that at least 80% of electronic prior authorization approvals will be answered in real-time.
Providing medical review of non-approved requests: All non-approved requests based on clinical reasons will be reviewed by medical professionals. This is already in effect.
“These measurable commitments – addressing improvements like timeliness, scope and streamlining – mark a meaningful step forward in our work together to create a better system of health,” said Kim Keck, president and CEO of Blue Cross Blue Shield Association, in a statement. “This is an important foundation to address bigger problems together, at a time when technology and interoperability can deliver real improvements to patient experience.”
Prior authorization has historically been a source of friction between payers and providers. A recent survey from the American Medical Association found that 93% of providers believe that prior authorization delays access to necessary care and 89% say that it increases physician burnout. Payers, meanwhile, argue that prior authorization is necessary to reduce costs and ensure that care is appropriate.
The American Medical Association came out in support of the prior authorization reforms, and specifically called out federal lawmakers for moving these reforms along.
“The American Medical Association has been a leading voice in the call for prior authorization reform during the last decade, and we therefore applaud Secretary Kennedy, Administrator Oz, and Deputy Administrator Klomp for their leadership in convening the health insurance industry to address the urgent need for prior authorization reform. The proposals announced today would help right-size and streamline a process that is harming our patients daily,” said Bobby Mukkamala, M.D., president of the American Medical Association.
“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,” Mukkamala added.
A leader of a prior authorization startup noted that the commitments can have a meaningful impact, but will require transparency and action.
“The most important next step is clarity: which services still require prior authorization, how decisions are being made, and whether payers are delivering measurable results,” said Dr. Jeremy Friese, founder and CEO of Humata Health, in an email. “We also know that the technology to enable real-time decisions already exists. To ensure this pledge leads to real change by 2027, we need to start now: with clear goals, shared accountability, and a belief that better, faster access to care is within reach.”
Photo: Piotrekswat, Getty Images
