Major U.S. Health Insurers Pledge Reform of Prior Authorization Process

On June 23, 2025, major U.S. health insurers, including UnitedHealthcare, Aetna, Cigna, Elevance Health, and Kaiser Permanente, announced a commitment to reform the prior authorization process—a system requiring insurer approval before covering certain medical services, medications, or procedures. This initiative, coordinated by America's Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association, aims to address longstanding criticisms from healthcare providers and patients regarding delays and administrative burdens associated with prior authorizations.

Prior authorization is a cost-control mechanism used by health insurers to determine the necessity and appropriateness of medical services before they are provided. While intended to prevent unnecessary treatments and manage healthcare expenditures, the process has been widely criticized for causing treatment delays, increasing administrative burdens, and negatively impacting patient outcomes. A 2024 survey by the American Medical Association (AMA) revealed that 94% of physicians reported prior authorization delays access to necessary care, and 33% indicated it led to a serious adverse event for a patient in their care.

The proposed reforms include reducing the number of services requiring prior authorization, standardizing the process across insurers, implementing real-time response systems, and ensuring that approvals remain valid for 90 days, even if a patient changes insurers during ongoing treatment. These changes are set to be implemented by January 1, 2027, and will apply to employer-sponsored, individual market, Medicare Advantage, and Medicaid coverage.

AHIP President and CEO Matt Eyles stated, "Health insurance providers are committed to improving the prior authorization process to ensure patients receive timely, high-quality care while reducing administrative burdens on healthcare providers." Dr. Bruce A. Scott, AMA President, commented, "The AMA welcomes this commitment from health insurers to reform prior authorization processes. We look forward to working collaboratively to implement these changes and ensure they effectively address the concerns of patients and physicians."

The reform initiative is expected to have several significant implications, including improved patient access to care, reduced administrative burden on healthcare providers, and potential cost savings. By decreasing unnecessary administrative tasks and preventing delays that can lead to more severe health issues, the healthcare system may experience overall cost reductions.

Prior authorization has been a contentious issue for years. In January 2024, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to improve the prior authorization process, aiming to reduce patient care delays and administrative burdens. The rule required insurers to implement electronic prior authorization systems and respond to urgent requests within 72 hours. Additionally, in December 2024, Senator Sheldon Whitehouse introduced the Prior Authorization Relief Act, seeking to alleviate administrative burdens associated with prior authorizations and expedite patient access to prescribed care.

This comprehensive overview provides the necessary factual information to craft a detailed and informative news article on the recent commitment by major U.S. health insurers to reform the prior authorization process.