Major insurers pledge prior authorization reform

Editor's Note

Nearly 50 major US health insurers—including UnitedHealthcare, Aetna, Cigna, Elevance, and Humana—have pledged to reform prior authorization practices, with the goal of easing administrative burdens and improving access to care, according to a June 23 article in Healthcare Dive.

As detailed in the article, the announcement came from insurance trade groups AHIP and the Blue Cross Blue Shield Association. They pledged six key commitments that could apply across commercial, Medicare Advantage, and Medicaid plans and could affect more than 250 million Americans. These commitments include:

• Reducing the volume of services requiring prior authorization
• Honoring existing prior auth approvals during a 90-day coverage transition
• Providing clear explanations for denials and guidance on appeals by 2026
• Standardizing data and submission processes for electronic prior authorization by 2027
• Responding to at least 80% of electronic prior authorization requests in real time by 2027
• Ensuring all denials are reviewed by qualified medical professionals.

Insurers have not yet set specific targets for how many prior authorization requirements will be eliminated, Healthcare Dive reports. Participating payers plan to release individualized reduction plans by next year.

As detailed in the article, CMS Administrator Dr Mehmet Oz touts the pledge as an opportunity for insurers to prove they can self-regulate, while provider and advocacy groups voice skepticism. See the full report for more detail on these objections as well as prior authorization generally, past reform efforts, and the broader context of public anger following the killing of UnitedHealthcare CEO Brian Thompson in December.