Health Insurers Pledge to Simplify Prior Authorization

In a major announcement, America’s Health Insurance Plans (AHIP) said that more than 50 major insurers — including UnitedHealthcare, Aetna, Cigna and various regional Blue Cross Blue Shield plans — have pledged to significantly streamline the prior authorization process and improve the patient care experience.

This shift could bring relief to more than 250 million Americans enrolled in commercial, Medicare Advantage and Medicaid managed care plans.

What’s changing?

The insurers committed to a six-part plan to reduce the administrative burden of prior authorization, modernize approval processes and improve the speed of care. Key changes include:

• Standardized electronic prior authorization submissions, targeted for 2027.
• Reduced prior authorization requirements for certain services, effective in 2026.
• Continuity of care protections for patients switching plans mid-treatment, ensuring prior approvals are honored for 90 days.
• Clearer communication about authorization decisions and appeals, set for implementation in 2026.
• Real-time approvals for at least 80% of electronic requests by 2027.
• Mandatory medical review of any denial based on clinical grounds, which is already in effect.

Evolution of prior authorization

Prior authorization was originally intended as a cost-control measure to ensure treatments are medically necessary and cost-effective. But for many patients and businesses, it has become a bureaucratic nightmare.

According to the American Medical Association’s (AMA) 2024 survey of practicing physicians:

• 93% reported that prior authorization delays access to necessary care.
• 82% said it sometimes causes patients to abandon treatment altogether.
• 88% believe it increases overall health care costs through ER visits, extra office appointments and hospitalizations.
• Nearly one in three reported that the process led to a serious adverse event, including hospitalization or even permanent harm.

While these delays have real consequences for health plan enrollees, for businesses that provide group health insurance, they can translate into reduced employee productivity, higher out-of-pocket costs for workers and lower satisfaction with benefit plans.

In recent years, there’s been a growing backlash against prior authorization and the toll it takes on time-sensitive care. Until now, insurers have been slow to change. But as dissatisfaction has grown, insurers like UnitedHealthcare and Aetna have started to make moves — such as eliminating requirements for certain medications or bundling approvals for cancer-related imaging tests.

AHIP’s new industrywide pledge is the most sweeping effort yet and signals that insurers recognize the pressure to act.

Will it work?

While the commitment marks a major policy shift, questions remain about how fast and how fully these changes will be implemented. As the AMA notes, similar voluntary pledges in the past haven’t produced substantial results. In fact, only 10% of physicians surveyed said they currently work with insurers offering programs that exempt “trusted” providers from repeated approvals.

Still, the promise to move toward real-time decisions and reduced authorization burdens — especially for high-performing doctors and common procedures — could ease friction and improve patient experience.

The takeaway for employers and health plan buyers

If AHIP’s reforms are implemented as promised, the impact on enrollees could be significant:

• Faster care: Less waiting for approvals could reduce time off work and lower stress.
• Lower costs: Fewer delays can prevent complications that lead to higher downstream medical bills.
• Simplified processes: Standardization and real-time digital systems will cut down on paperwork and confusion.