Insurers Commit to Massive Overhaul of Prior Authorization

In a rare display of unity, America’s largest health insurers, led by industry giants United Healthcare, Aetna/CVS Health, Cigna, Humana, and Kaiser Permanente, have pledged sweeping reforms to the notorious “prior authorization” process. This move signals a major shift after years of mounting criticism aimed at how bureaucratic hurdles are delaying medical care, frustrating doctors, and undermining patient well‑being.

What is Changing?

According to their public commitment, insurers will:

• Slash the scope of treatments, drugs, and procedures requiring prior approval, meaning fewer interventions will need upfront sign‑off.
• Standardize electronic requests, fully rolling out e‑forms and automating approvals across Medicare, Medicaid, employer-sponsored and ACA plans by the end of 2026.
• Guarantee 90‑day carryover of authorizations if patients switch plans mid‑treatment, eliminating the need to reapply.
• Boost real‑time approvals, aiming for at least 80 % of clinical decisions to be made instantly once full information is provided.

These reforms are part of a broader strategy to smooth workflows for physicians, who often face weeks-long waits, and to ease care access for the 250+ million Americans affected.

Why Now?

Several forces converged to propel this shift, including decades of physician burnout and patient delays stemming from outdated, manual prior authorization processes, characterized by extensive paperwork and reliance on fax-based communications. Additionally, heightened public scrutiny following the tragic death of United Healthcare CEO Brian Thompson in December 2024 significantly intensified criticism of insurance practices, turning the incident into a catalyst for reform.

Federal regulations have further increased pressure, as CMS now mandates that hospitals, urgent care centers, and Medicare Advantage plans adhere to stringent turnaround times, 72 hours for urgent requests and seven days for non-urgent ones, and implement standardized electronic processes by 2027.

Lastly, active legislative efforts across multiple states, including Indiana, Nebraska, Montana, Alaska, and Colorado, have imposed strict requirements, such as mandated response times, specialty-level appeals, prohibitions on retroactive denials, and random audits, further compelling insurers toward meaningful reform.

What Does This Means for Patients & Providers?

The upcoming changes hold significant promise for both patients and healthcare providers. For patients, streamlined processes will mean faster access to medical care, especially for routine procedures like imaging, specialty medications, or physical therapy, reducing delays that have traditionally impacted timely treatment. Providers will also experience substantial relief, as simplified and standardized electronic processes will significantly reduce the hours doctors and their staff currently spend navigating approvals each week. Additionally, new provisions allowing authorizations to carry over for 90 days when patients switch plans mid-treatment will ensure greater continuity of care, eliminating frustrating interruptions. Lastly, these reforms bring greater transparency, with electronic requests clearly outlining reasons for denials and requiring insurers to publicly report their prior authorization metrics, giving both patients and providers more insight and accountability into coverage decisions.

What Still Needs Attention?

• Limits remain: This initiative doesn’t eliminate prior authorization; it only reduces burdens.
• Delayed timeline: Full automation and real-time systems are still a year or more away. Real-world impact depends on digital infrastructure rollout.
• Drug approvals excluded from CMS timelines: Prescription authorizations, especially for chronic or specialty medications, aren’t covered in current federal timeframe.

What is the Bottom Line?

This is the most substantial voluntary reform by insurers to date, backed by federal rules and state-level mandates. For patients, it means fewer barriers and faster care. For providers, it offers more clarity and less paperwork. But the journey is far from over—real improvement hinges on successful tech integration and sustained regulatory oversight.