In June 2025, health plans made a series of commitments to improve prior authorization. On Tuesday, insurer advocacy organization AHIP and the Blue Cross Blue Shield Association gave their first updateannouncing that health plans have eliminated 11% of prior authorizations since the commitments were made.
This represents 6.5 million fewer prior authorizations. In Medicare Advantage, prior authorizations are down 15%.
“Health plans have taken important initial steps to support patients and are working toward the common goal of providing answers at the point of care whenever possible – a goal that will require both plans and providers to eliminate manual processes and adopt real-time electronic data sharing,” said Mike Tuffin, president and CEO of AHIP.
The multi-year commitments are made in partnership with the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services. Several of the commitments took effect in January, while others will take effect in 2027. The commitments for 2026 include:
- Reduce the scope of claims subject to prior authorization: Insurers are reducing pre-authorization requirements for certain claims, which depend on the market served by each plan. Services removed from prior authorization requirements include those that benefit from evidence-based guidelines and have demonstrated improvements in outcomes, according to Tuesday’s announcement.
- Ensure continuity of care when patients change plans: When patients change insurance plans during treatment, their new insurer must honor existing prior authorizations for similar in-network services for 90 days to ensure continuity of care and avoid delays. For this engagement, many plans have created secure data sharing processes to coordinate ongoing processing, AHIP and BCBSA said.
- Improve communication and transparency on determinations: Insurers have committed to providing clear explanations of prior authorization determinations, as well as information on appeals. This coverage became available for fully insured and commercial coverage in January. To improve communication, payers implemented “friendly language” and provided “simple notices and determinations.”
In 2027, payers will focus on standardizing electronic prior authorizations and expanding real-time responses.
“Going forward, we will focus on our commitment to processing 80 percent of electronic prior authorization requests in real time, at the speed of care. We share CMS’s urgency to modernize health care infrastructure and understand that all of us – policymakers, payers and care providers – have a role to play in enabling change,” said Kim Keck, CEO of the Blue Cross Blue Shield Association.
An employer advocate called the changes “good first steps toward real-time prior authorization decisions.”
“It is critical that employers remain engaged and active in promoting prior authorization improvements that meet our shared goals for affordability and quality, with a particular focus on reducing friction for employees, their families and clinicians,” said Shawn Gremminger, president and CEO of the National Alliance of Healthcare Purchasing Coalitions.
Families USA, a patient advocacy organization, said it appreciated the steps to improve prior authorization, but that additional steps were needed.
“Voluntary commitments recognize the problem, but they are no substitute for a statutory solution, with enforceable standards and accountability,” said Anthony Wright, executive director of the organization. “Sustainable change requires clear consumer protections, legislative action and rigorous oversight to ensure patients receive the care they need, regardless of how they are insured. »
Photo: Piotrekswat, Getty Images