In June 2025, health insurers pledged to simplify and reduce prior authorization requirements, affecting plans covering 257 million Americans. It’s been over one year since, and, while payers have been vocal about their progress, there are still big steps left to take.
The Wall Street Journal initially reported the anticipated changes June 20, 2025, with details rolling out a few days later. The pledge included working toward a standardized submission process for electronic prior authorizations that aimed to be operational and accessible by 2027. Insurers would strive for at least 80% of electronic prior authorization approvals to be done in real-time. Under the commitments, plans would focus on boosting transparency with prior authorization decisions, too.
In the months that followed, the American Hospital Association pushed for insurers and federal officials to follow through with promises. In a September 2025 letter, AHA wrote that 95% of hospitals said the time their team has spent on prior authorization approval increased in the past year.
“We encourage CMS to actively monitor plans’ progress to ensure they honor these commitments, including full implementation of existing regulations such as the Interoperability and Prior Authorization final rule and reforms issued in the 2024 Medicare Advantage final rule,” the letter said, referencing earlier relevant rules. Public prior authorization data, stemming from a 2024 rule, has offered only limited insight, KFF reported in April.
That same month, AHIP and the Blue Cross Blue Shield Association released survey results showing health plans had cut 11% of prior authorization requirements and reiterated ongoing efforts.
“During the past 10 months, the Blues made significant, measurable strides toward delivering on our promise to make this process faster, simpler and more transparent,” BCBS Association CEO Kim Keck said in the news release. “Moving forward, we will focus on our commitment to address 80% of electronic prior authorization requests in real-time, at the speed of care. We share CMS’ urgency to modernize the infrastructure of healthcare and understand that all of us — policymakers, payers and care providers — have a role to play in activating change.”
Other insurers have boasted prior authorization cuts in recent months. Elevance Health, UnitedHealthcare, Humana, Aetna and Cigna have announced prior authorization cuts or standardization goals. When health insurance CEOs faced Congress in January 2026, UnitedHealth Group CEO Stephen Hemsley defended his company and said prior authorization reforms had been underway. Still, some announced cuts lack context on the affected services. Despite payers’ self-reported wins leading up to the 2025 pledge, the American Medical Association reported that not all physicians have felt the effects.
One year in, electronic prior authorization is a central focus. Payers signed an AHIP and Blue Cross Blue Shield Association commitment to standardize electronic prior authorization in April, reinforcing the priority. The pledge has expanded beyond payers, as well: Providers and EHR vendors are also now preparing for Jan. 1, 2027, the go-date for application programming interface requirements established by the Interoperability and Prior Authorization final rule.
Regulatory changes
At the federal level, CMS has been layering new prior auth requirements onto payers while also proposing to extend the current framework even further.
Under the 2024 Interoperability and Prior Authorization Rule, payers were required to begin publicly posting prior auth metrics for the first time, with the first reports covering 2025 data due March 31. Required disclosures include approval rates, denial rates, decision turnaround times and appeals outcomes for medical items and services. MA plans report at the contract level, while Medicaid programs report at the state level. The same rule requires plans to issue decisions on standard prior auth requests within seven calendar days and urgent requests within 72 hours, effective in 2026.
On May 5, CMS Administrator Mehmet Oz, MD, announced the next phase of the initiative, expanding the effort beyond insurers to include hospitals, physician practices, EHR vendors and digital health developers. The new coalition will align on interoperability rule deadlines and address workflow gaps. Under the 2024 rule, payers must also build out a suite of API capabilities by January 1, 2027, covering patient access, provider access, payer-to-payer record transfers and electronic prior auth submission and response. CMS estimates these policies will save approximately $15 billion over 10 years.
Building on that framework, CMS also proposed a rule in April extending the interoperability requirements to cover drugs for the first time. The proposed rule would require Medicaid, CHIP and ACA plans to support three pharmacy data standards by October 2027, enabling providers to query formulary information, check real-time coverage and submit electronic requests for drugs. ACA plans would be required to respond to standard drug requests within 72 hours and expedited requests within 24 hours. The proposal would also expand public reporting requirements to include drugs, require payers to provide specific denial reasons for drug requests, and adopt HL7 FHIR standards for prior auth transactions under HIPAA across all covered entities.
At the state level, at least five states have enacted their own reforms taking effect in 2026.
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