Prior authorization in 2025: What to know 

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In June, around 50 insurers pledged their commitment to a set of voluntary actions aimed at simplifying the prior authorization process.

The group of insurers, backed by leaders including CMS Administrator Mehmet Oz, MD, said they will work to implement a standard submission process for electronic prior authorizations. Individual insurers will also commit to specific reductions for prior authorizations. 

Dr. Oz called the move “a step in the right direction toward restoring trust [and] easing burdens on providers.” 

American Medical Association President Bobby Mukkamala, MD, said the move is recognition the current system is not working, but physicians need specifics demonstrating the initiative “will yield substantive actions.” 

“The AMA will closely monitor the implementation and impact of these changes as we continue to work with federal and state policymakers on legislative and regulatory solutions to reduce waste, improve efficiency, and, most importantly, protect patients from obstacles to medically necessary care,” Dr. Mukkamala said. 

The insurers’ pledge comes after years of increasing frustration from providers and patients, and regulatory actions from the federal government and states. 

Here is what to know: 

The state of prior authorization 

The average medical practice completed 43 prior authorizations per physician, per week, in 2024, according to an AMA survey. Physicians and staff reported spending about 12 hours per week completing such paperwork. 

The vast majority of physicians surveyed by the AMA cited prior authorization as a contributor to burnout. 

Data analyzed by KFF found the number of prior authorizations in Medicare Advantage grew each year from 2021 to 2023. In 2023, MA insurers denied 3.2 million, or 6.4%, of prior authorization requests. Though the volume of prior authorizations increased from 2022 to 2023, the number of denials declined. 

Changes coming in 2026 and 2027

Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, said the reforms insurers have agreed to are similar to requirements that have been previously mandated by CMS for Medicaid and Medicare Advantage plans.

“It makes sense for them to implement changes across commercial products as well,” Mr. Gilberg said.

In 2024, CMS finalized new rules affecting Medicare Advantage and Medicaid plans, designed to speed up the prior authorization process. Beginning in 2026, plans will be required to send urgent prior authorization decisions within 72 hours, and all other decisions within seven days.

In 2027, most Medicaid and MA plans will be required to implement automated electronic prior authorization systems.

In recent years, insurers have reduced the number of services subject to prior authorizations. In 2023, UnitedHealthcare cut its prior authorization requirements by 20%. At least six other insurers made similar moves in 2023 and 2024.

UnitedHealthcare has said it will reduce the number of services requiring prior authorization by 10% in 2025. The insurer has also implemented “gold card” programs, which exempt providers with high approval rates from most prior authorization requirements.

In a 2022 AHIP survey, insurers said gold card programs can reduce provider burden, but have proved difficult to implement administratively.

AI concerns 

The use of AI in prior authorization has emerged as a concern for providers and regulators.

Humana and UnitedHealth are facing lawsuits alleging they used AI algorithms to wrongfully deny care to MA members. Insurers have said they do not use AI to deny care. 

In 2024, CMS issued guidance to MA insurers around the use of AI in prior authorization. The agency said plans can use AI and automation tools in prior authorization, but these tools must comply with all agency guidelines, including those around discrimination and bias. 

In 2025, the agency declined to implement rules regulating the use of AI in prior authorization. States have considered regulations on how insurers can use AI. Also in 2025, California implemented regulations prohibiting insurers from using AI alone to make coverage decisions.

Regulations on the table

Many states have implemented laws limiting when prior authorization can be used. In 2024, at least 10 states passed legislation related to prior authorization. The scope of legislation varies by state, but the laws generally aim to cut the number of services subject to prior authorization, and to speed up decision times. Several other states have put forth prior authorization proposals in 2025. 

On the federal level, lawmakers reintroduced the Improving Seniors’ Timely Access to Care Act in May 2025. The bill would establish an electronic prior authorization process for Medicare Advantage plans, standardize transactions and clinical attachments, increase transparency, and clarify HHS’ authority to set time frames for requests. 

Insurers have backed the legislation. Jim Rechtin, president and CEO of Humana, said the legislation is “a common-sense approach to making healthcare easier by modernizing the prior authorization process.” The proposal is also backed by the AMA. 

The AMA adopted a slate of prior authorization reform proposals in 2024, including increasing legal accountability for insurers whose prior authorization policies harm patients. 

In a June statement, Dr. Oz said prior authorization issues should be solved through “voluntary actions by the private sector.” 

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