From UnitedHealthcare planning to cut prior authorization by 10% in 2025 to a congressman reintroducing reform legislation on, here are nine prior authorization updates that Becker’s has reported on since March 3:
1. Rep. Mark Green, MD, of Tennessee reintroduced legislation taking aim at prior authorization requirements in Medicare, Medicare Advantage and Part D prescription drug plans.
2. CMS published its final rule for Medicare Advantage and Part D in 2026 but declined to finalize rules that would have placed guardrails around the use of AI in prior authorization decisions.
3. Several states, including California, are considering regulating how insurers can use AI in prior authorization.
4. Hawaii lawmakers introduced legislation that would require insurers to report data related to prior authorization to the state and introduce specific timelines for the approval of prior authorization requests for both urgent and non-urgent services.
5. Optum Rx, the pharmacy benefit manager under UnitedHealth Group, is removing prior authorization requirements for approximately 80 prescription drugs, aiming to streamline access for patients with chronic conditions.
6. North Carolina lawmakers introduced legislation that would require payers to notify physicians within a specific timeframe if the medical necessity of a service is being questioned. It would also mandate that payers publicly disclose a list of the medical services that require a prior authorization review, and set a 48-hour deadline for insurers to notify physicians and patients about nonemergency service approvals.
7. While commercial insurers often use prior authorization as a way to control costs, it does the opposite for patients undergoing total hip arthroplasty, according to a study presented at the 2025 American Academy of Orthopaedic Surgeons annual meeting in San Diego.
8. Charleston, S.C.-based MUSC Health deployed AI agents from healthcare software company Notable to execute 40% of prior authorizations without human involvement.
9. UnitedHealthcare plans to cut prior authorization requirements by around 10% in 2025.
