Officials with the Department of Health and Human Services (HHS) met recently with industry leaders to discuss measures that they say will streamline and improve the prior authorization processes for Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace, and commercial plans.1
In a roundtable discussion hosted by HHS, health insurers pledged 6 key reforms they say are designed to cut red tape, accelerate care decisions, and enhance transparency for patients and providers.
Specifically, the aim is to standardize electronic prior authorization requests by 2027, and participating health insurers pledged to expand real-time responses to minimize delays in care with real-time approvals for most requests by 2027.
The plan also aims to reduce the volume of medical services subject to prior authorization by January 1, 2026, and ensure medical professionals review all clinical denials.
Their commitments reinforce the role of the Centers for Medicare & Medicaid Services (CMS) in monitoring outcomes and promoting accountability. Companies represented at a roundtable to discuss the initiative included Aetna, Blue Cross Blue Shield Association, CareFirst BlueCross BlueShield, Centene Corporation, The Cigna Group, Elevance Health, GuideWell, Highmark Health, Humana, Kaiser Permanente, and UnitedHealthcare.
“Americans shouldn’t have to negotiate with their insurer to get the care they need,” HHS Secretary Robert F. Kennedy, Jr, said in a prepared statement about the initiative. “Pitting patients and their doctors against massive companies was not good for anyone. We are actively working with industry to make it easier to get prior authorization for common services such as diagnostic imaging, physical therapy, and outpatient surgery.”
In a response statement from American Medical Association (AMA) President Bobby Mukkamala, MD, said, “despite widespread calls for meaningful reforms and the insurance industry’s past promises, the prior authorization process remains costly, inefficient, opaque, and too often hazardous for patients. That is why the AMA enthusiastically supported recent federal regulations that applied reforms to limited health insurance markets, including Medicare Advantage. We are optimistic that health plans’ pledge to expand the scope of several of these important reforms to other insurance types will provide more patients and physicians with relief.”2
Mukkamala added that patients and physicians will need specifics demonstrating that the “latest insurer pledge will yield substantive actions to bring immediate and meaningful changes, break down unnecessary roadblocks, and keep medical decisions between patients and physicians. The AMA will closely monitor the implementation and impact of these changes as we continue to work with federal and state policymakers on legislative and regulatory solutions to reduce waste, improve efficiency, and, most importantly, protect patients from obstacles to medically necessary care.”
Mehmet Oz, MD, CMS Administrator, said in the statement from HHS that the pledge “represents a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care. We applaud these voluntary actions by the private sector, which is how these types of issues should be solved. CMS will be evaluating progress and driving accountability toward our shared goals, as we continue to champion solutions that put patients first.”1
References
- Department of Health and Human Services. HHS Secretary Kennedy, CMS Administrator Oz Secure Industry Pledge to Fix Broken Prior Authorization System [press release]. June 23, 2025. Accessed June 30, 2025. www.hhs.gov/press-room/kennedy-oz-cms-secure-healthcare-industry-pledge-to-fix-prior-authorization-system.html
- American Medical Association. AMA responds as health insurers try again at prior authorization reform [prepared statement]. June 24, 2025. Accessed June 30, 2025. www.ama-assn.org/press-center/ama-press-releases/ama-responds-health-insurers-try-again-prior-authorization-reform