Amazon, Axon, Google, Meta and Oracle are asking the insurers and third-party administrators that run their health plans to expand electronic prior authorization upgrades, first promised under a 2025 federal pledge, to the self-funded market.
CMS and the Labor Department announced the employers’ statement of support Oct. 21. Self-funded employer plans aren’t subject to the federal rule requiring Medicare Advantage, Medicaid, CHIP and ACA marketplace plans to support electronic prior auth starting in 2027. They also aren’t required to publish prior auth denial data that those plans were required to make public earlier this year.
Here are six things to know:
1. The statement asks the more than 50 insurers that took part in the original prior auth pledge and TPAs to make their technical improvements “immediately available” to self-insured plan sponsors, writing that they would benefit from the electronic upgrades if they are administered on the systems insurers are building under the pledge. Other changes, such as cutting the number of services that require prior auth, would be adopted plan by plan.
The employers themselves did not commit to reducing prior auth within their own plans and said they would consider those possible changes against their fiduciary duties under ERISA.
2. In June 2025, around 50 insurers pledged to simplify prior auth across MA, Medicaid, ACA marketplace and fully-insured plans covering a total of 257 million Americans. They committed to a standardized electronic submission process starting next year, real-time answers for at least 80% of electronic approvals, fewer services subject to prior auth and more transparency around how decisions are made.
The pledge runs alongside CMS’ Interoperability and Prior Authorization final rule, which requires MA, Medicaid and ACA plans to let clinicians submit prior auth requests and get decisions through their EHRs starting next year. CMS previously estimated the rule’s policies will save about $15 billion over 10 years.
3. AHIP and the BCBS Association said in April that participating plans had cut 11% of prior auth requirements so far, or 6.5 million prior authorizations, though the two industry groups did not release the underlying claims data or methodology behind the figures. Elevance Health, UnitedHealthcare, Humana, Aetna and Cigna have announced their own reductions or standardization goals over the last several years.
In April, CMS proposed an extension of the electronic requirements to prescription drugs. Under that proposal, Medicaid, CHIP and ACA plans would have to support three pharmacy data standards by October 2027, matching a requirement Medicare Part D plans already follow. In May, CMS expanded the reform efforts to include pledges from hospitals, physician practices, EHR vendors and digital health developers.
4. The AMA has urged CMS to keep the Jan. 1, 2027, deadline in place, saying in September some stakeholders have been seeking a delay. The organization also said insurers are portraying limited physician engagement so far as a lack of interest, when physicians actually need more education and support from plans and EHR developers.
5. The interoperability rule also required insurers to begin publicly reporting prior auth metrics earlier this year. MA, Medicaid managed care and ACA marketplace insurers denied 12%, 14% and 18% of standard requests in 2025, respectively, according to a KFF analysis of the first year of data. Few denials were appealed, and when they were, 67% of MA denials were overturned, along with 47% in Medicaid and 43% on the marketplace.
Still, the data offers limited insight because it’s aggregated across all services and doesn’t include the reasons for denials. Insurers also report percentages rather than counts, so a large insurer with a low denial rate could still deny more requests overall than a smaller plan with a higher rate.
6. CMS and the Labor and Treasury departments finalized an overhaul of price transparency rules for payers and self-insured employers in early October. In revised files required to go public next April, insurers must stop including rates for services a provider is unlikely to be paid for given its specialty, post one in-network rate file per provider network instead of one per plan, and have a senior plan executive attest that the data is accurate and complete.
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