Insurers say prior auth fell 11%
Major insurers report an 11% drop in prior authorisation volume over the past year after industry pledges to simplify approvals. That sounds like real progress, but the reductions come from insurer announcements rather than a completed rebuild of the APIs and interfaces that drive approvals. For clinicians and informaticists, it means fewer manual steps today but ongoing opportunity—and need—to design interoperable workflows that prevent a rebound in administrative burden. (axios.com)
Health insurers say they handled 11% fewer prior authorization requests over the past year, after a June 2025 pledge by major plans to cut back on which services need approval in the first place. The new figure came from America’s Health Insurance Plans on April 7, 2026, not from a federal audit or a new government dataset. (ahip.org) (axios.com) Prior authorization is the insurer’s version of asking for permission before care starts. A doctor orders a scan, drug, or procedure, and the insurer can require extra paperwork before it agrees to pay. (ama-assn.org) (ahip.org) The fight over prior authorization got so loud because the process still runs on old plumbing. America’s Health Insurance Plans said in January 2026 that many providers still rely on fax machines, and the industry’s newer electronic system is not supposed to be broadly operational until January 1, 2027. (ahip.org 1) (ahip.org 2) That timing is the key to this week’s claim. If requests fell in 2025 and early 2026, most of that drop came from insurers removing some services from the approval list, not from a finished rebuild of the application programming interfaces that let software talk directly to software. (ahip.org) (cms.gov) The June 2025 pledge had four deadlines, and they were split across two years. Plans said they would cut some medical prior authorizations and honor existing approvals for 90 days when patients switch insurers by January 1, 2026, while the standardized Fast Healthcare Interoperability Resources-based application programming interface framework is aimed for January 1, 2027. (ahip.org) (cms.gov) The federal rule is moving on a different track from the voluntary pledge. The Centers for Medicare & Medicaid Services finalized a rule on January 17, 2024, that requires certain Medicare Advantage, Medicaid, Children’s Health Insurance Program, and federally facilitated exchange plans to publish prior authorization metrics starting in 2026 and to meet application programming interface requirements by January 1, 2027. (cms.gov 1) (cms.gov 2) (cms.gov 3) That means the system is in an in-between stage right now. A doctor may face fewer approval requests than last year, but when an approval is still required, the handoff between the doctor’s record system and the insurer’s system can still be clunky because the shared digital rails are not fully in place yet. (axios.com) (cms.gov) Doctors’ groups have pushed for years to narrow prior authorization because they say delays can block care. The American Medical Association said in July 2025 that insurer promises were landing while state and federal policymakers were already considering tougher limits on the practice. (ama-assn.org) So the 11% drop is real in the narrow sense that insurers are reporting fewer requests, but it does not mean the hard part is finished. The next test arrives in 2026 and 2027, when public metrics and new application programming interfaces will show whether fewer approvals also turn into fewer phone calls, fewer faxes, and fewer dead ends for patients and clinics. (ahip.org) (cms.gov)
