Insurers say prior auth fell 11%
AHIP and the Blue Cross Blue Shield Association report an 11% reduction in prior authorizations over the past year, a headline insurers are using to show reform progress. Analysts caution this doesn't necessarily translate to less front-line friction or clearer approvals, so providers still need tools that speed adjudication and document medical necessity. (axios.com)
Health insurers say they cut prior authorization requirements by 11% in the past year, which they translate into about 6.5 million fewer approval requests for patients. The report came from America’s Health Insurance Plans and the Blue Cross Blue Shield Association, the two trade groups leading a June 2025 reform pledge with federal officials. (ahip.org) Prior authorization is the checkpoint where a doctor orders a drug, scan, or procedure, and the insurer says “ask us first” before it will pay. The American Medical Association defines it as advance approval required before a prescription medication or medical service qualifies for payment and can be delivered. (ama-assn.org) About 50 plans joined the 2025 pledge, including Elevance Health, Centene, Cigna, Aetna, Humana, and UnitedHealthcare. Those plans promised to remove some services from prior authorization lists, use clearer denial notices, and build more electronic processing by January 1, 2027. (fiercehealthcare.com) The biggest reported drop was in Medicare Advantage, where the trade groups said prior authorizations fell by more than 15%. The same update said Blue Cross plans are now aiming to handle 80% of electronic prior authorization requests in real time. (ahip.org) That sounds like a cleaner system, but patients are still telling pollsters this is the worst part of using insurance after premiums and deductibles. A February 2026 KFF poll found 69% of insured adults said prior authorization is a burden, and 32% called it a major burden. (kff.org) Doctors are even harsher, because they see the pileup from the other side of the desk. In the American Medical Association’s 2024 survey of 1,000 physicians, 93% said prior authorization delays necessary care, 94% said it has a negative effect on outcomes, and 82% said it can lead patients to abandon treatment. (ama-assn.org) The gap between “11% fewer rules” and “still a major burden” comes from how the process works in real clinics. A plan can remove some low-volume requirements and still leave staff chasing faxes, portal logins, missing records, and vague medical-necessity questions on the cases that remain. (fiercehealthcare.com) Washington has been trying to force the plumbing to improve, not just the press release. A Centers for Medicare & Medicaid Services rule finalized on January 17, 2024 requires Medicare Advantage, Medicaid, and some exchange plans to send urgent prior authorization decisions within 72 hours and standard decisions within seven calendar days. (cms.gov) That same federal rule also requires many insurers to publish prior authorization metrics on their public websites beginning in 2026, including denial rates, appeal overturn rates, and processing times. The first public reporting deadline was March 31, 2026, so the black box is starting to open. (cms.gov) So the real test is no longer whether insurers can announce a smaller number. The real test is whether a cardiology office, cancer clinic, or primary care practice can get a yes in minutes instead of days, with a clear reason when the answer is no. (cms.gov)
