Settling into 2026, prior authorization continues to be a contentious topic for payers, providers, lawmakers and other leaders. From piloting prior authorization in Medicare to governors pitching reforms, this year is already featuring major shifts.
Here are seven prior authorization updates in 2026, so far:
1. State lawmakers have been suggesting a series of prior authorization reforms. A Jan. 21 Kentucky bill would require insurers to establish programs around exemptions, and a Missouri state senator pitched a bill that would cut prior authorization requirements beginning in August. State laws across North Dakota, Nebraska and Alaska went into effect at the top of 2026, pushing insurers to quicken prior authorization response times.
2. CVS Health reported roughly half as many prior authorizations as its closest competitor, the company said Jan. 22. The company added that it approves more than 95% of requests within one day and 77% of electronic submissions in real time, with an expectation of reaching 80% by the end of the year.
3. Denial rates and prior authorization took center stage at two congressional hearings Jan. 22 featuring leaders from UnitedHealth Group, CVS Health, Elevance Health, Cigna, and Blue Shield of California’s parent company, Ascendiun. UnitedHealth CEO Stephen Hemsley said the company is working to reduce prior authorizations, building on industrywide commitments from 2025.
4. Ninety-three percent of health plan executives expect AI to add value by automating prior authorizations, according to an analysis of Deloitte survey results released Jan. 15.
5. On Jan. 14, Massachusetts Gov. Maura Healey pitched 24-hour turnaround times for urgent prior authorization requests and eliminating prior authorization for certain conditions, along with other reforms. She also shared the Health Care Affordability Working Group, which will include Blue Cross Blue Shield of Massachusetts President and CEO Sarah Iselin and Massachusetts Association of Health Plans President and CEO Lora Pellegrini.
6. Just a day prior, New York Gov. Kathy Hochul also proposed a handful of healthcare initiatives for her state, including reforms for prior authorization. Under her pitch, prior authorizations for some chronic conditions would last longer, the state would run a public education campaign for consumers and providers, and some data sharing would be required.
7. CMS’ Wasteful and Inappropriate Service Reduction initiative also kicked off this year, with providers in Arizona, Washington, New Jersey, Texas, Ohio and Oklahoma piloting the new protocol. For the first time, some services under traditional Medicare face prior authorization requirements.
Note: This story was updated Jan. 28 and will continue to be updated throughout the year.
