Insurers have eliminated 11% of prior authorization requirements across a range of medical services since June, representing 6.5 million fewer prior authorizations for members, according to an AHIP-Blue Cross Blue Shield Association survey published April 7.
Five notes:
- The 11% reduction includes a drop of more than 15% for Medicare Advantage plans. Services removed from needing prior authorization include those with evidence-based clinical guidelines, consistent utilization patterns and demonstrated improvements in patient outcomes.
- The reductions stem from voluntary commitments made in June 2025 by nearly 50 insurers, in partnership with the federal government, to streamline and simplify prior authorization across commercial, MA and managed Medicaid plans covering 257 million Americans. Individual plans committed to specific reductions, which took effect at the start of the year.
- Participating insurers have also implemented a 90-day continuity of care policy, honoring existing prior authorizations for benefit-equivalent, in-network services when a patient switches insurers mid-treatment. Plans said they have established data-sharing processes and enhanced customer service support to handle new continuity of care requests.
- The update arrives as new prior auth public reporting requirements went live at the end of March under a rule finalized by CMS in 2024, which requires insurers to post metrics on how often they deny prior auth requests and how often denials are overturned on appeal. A KFF analysis published April 2 found the data offers little insight, noting that it is aggregated across all items and services with no breakdown by service type, and that payers are not required to report reasons for denials.
- The industry’s next phase of commitments takes effect in 2027, when plans must implement a standardized electronic prior authorization submission process and process at least 80% of electronic prior authorization approvals in real time. CMS’s 2024 rule also triggers additional API requirements that year, including a prior auth API capable of receiving and responding to requests electronically.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
