Major U.S. health insurers have voluntarily pledged to streamline and reduce prior authorizations—a process often criticized for delaying patient care and overwhelming providers. Prior authorization requires healthcare providers to obtain approval from insurers before delivering certain services, which insurers argue ensures necessity and controls costs.
However, critics say it can result in delayed treatment, denied care, and increased physician burnout. This new commitment aims to alleviate these issues and improve the healthcare experience for patients and providers alike.
Major Insurers Commit to Streamlined Prior Authorizations, Benefiting 257 Million Americans Nationwide
Dozens of health plans under major insurers, including CVS Health, UnitedHealthcare, Cigna, Humana, Elevance Health, and Blue Cross Blue Shield, have agreed to adopt reforms. The industry group AHIP announced these companies will implement changes to connect patients to care more swiftly while easing administrative burdens on healthcare professionals.
Although these changes could lead to higher care utilization and potentially affect profits, insurers expressed strong support. Aetna President Steve Nelson emphasized the need for a more patient-centric healthcare system and the importance of simplifying prior authorizations.
Health Insurers Pledge Sweeping Cuts to Prior Authorizations, Aiming for Faster Care by 2026The agreed-upon reforms will be rolled out across multiple markets, covering commercial, Medicare, and some Medicaid plans. These changes are expected to benefit up to 257 million Americans. One key initiative includes setting a universal standard for submitting electronic prior authorization requests by 2027.
At least 80% of such requests, when accompanied by necessary clinical documentation, are expected to receive real-time responses. This standardization aims to replace inefficient manual processes and significantly reduce the workload for medical providers.
Insurers to Cut Prior Authorization Requirements, Promising Simpler, Faster Patient Care by 2026
By 2026, individual insurance plans will reduce the number of treatments and services requiring prior authorization. Industry leaders and stakeholders, including the American Academy of Family Physicians, welcomed this move and emphasized the importance of collaboration to ensure lasting improvements in patient care.
At a related event, CMS Administrator Mehmet Oz and Health and Human Services Secretary Robert F. Kennedy Jr. praised the initiative for setting clear timelines and expanding coverage to an unprecedented number of patients. They expressed optimism that more insurers would join the initiative.
This announcement follows a period of public scrutiny for the health insurance industry, intensified by the murder of UnitedHealthcare’s CEO, Brian Thompson. It builds upon ongoing efforts by several insurers to simplify prior authorization.
UnitedHealthcare highlighted its continued dedication through programs like the Gold Card initiative, which rewards providers who consistently follow evidence-based guidelines by reducing their authorization requirements. The latest commitment represents a significant step forward in addressing one of the most criticized aspects of the U.S. healthcare system.
