Major U.S. health insurers announced on Monday their voluntary agreement to expedite and simplify the prior authorization process, a system frequently criticized by both patients and healthcare providers for creating obstacles in receiving and delivering care.
Prior authorization necessitates that healthcare providers obtain consent from a patient’s insurer before executing specific procedures or treatments. While insurers maintain that this approach ensures patients receive necessary medical care and helps manage costs, it has been widely criticized for contributing to delays in treatment, denials of care, and increasing stress among physicians.
The initiative includes numerous health plans from prominent insurers such as CVS Health, UnitedHealthcare, Cigna, Humana, Elevance Health, and Blue Cross Blue Shield. According to a release by the trade association AHIP, the actions are designed to enhance patient access to care and minimize the administrative complexities faced by healthcare providers.
The adjustments will be applied across various markets, including commercial insurance as well as specific Medicare and Medicaid plans, ultimately impacting approximately 257 million Americans.
This decision arrives in the wake of significant public scrutiny directed at the health insurance sector, particularly following the tragic death of UnitedHealthcare’s executive Brian Thompson. It also builds on ongoing efforts by multiple organizations to streamline their prior authorization systems.
Key initiatives include the establishment of a universal standard for electronic prior authorization requests, targeting implementation by early 2027. By that time, the goal is for at least 80% of electronic prior authorization approvals that include all necessary clinical documentation to be processed in real time, according to the announcement.
This shift aims to enhance efficiency and alleviate the burdens placed on doctors and hospitals, many of whom currently rely on manual, paper-based request submissions.
Additionally, individual plans are required to decrease the range of claims that necessitate prior authorization requests by 2026.
Shawn Martin, CEO of the American Academy of Family Physicians, expressed optimism about the new changes, stating in the announcement, “We look forward to collaborating with payers to ensure these efforts lead to meaningful and lasting improvements in patient care.”
