Health plans reduce prior authorization

WASHINGTON, D.C. — Health plans today announced an update on commitments to streamline, simplify and reduce prior authorization, a critical safeguard to ensure their members’ care is safe, effective, evidence-based and affordable. 

Since making the commitments, leading health plans eliminated 11% of prior authorizations across a range of medical services, representing 6.5 million fewer prior authorizations for patients. This reduction is helping to ease administrative burdens and speed access to evidence-based care. Health plans also affirmed improvements that make it easier for members who switch insurance to maintain their prior authorization approvals, known as continuity of care, and enhanced communications on prior authorization determinations.

These actions are part of a series of multi-year voluntary commitments announced in June 2025 in partnership with the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) to streamline and simplify prior authorization. Additional components of the commitments take effect in 2027, and taken together, these collective improvements will lead to a faster, more standardized and simplified experience, benefiting patients and providers.

“Health plans have taken important initial steps to support patients and are working toward the shared goal of delivering answers at the point of care whenever possible—a goal that will require both plans and providers to eliminate manual processes and adopt real-time electronic data sharing,” said Mike Tuffin, AHIP President and CEO.

“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,” said Kim Keck, CEO of the Blue Cross Blue Shield Association. “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 health care and understand that all of us – policymakers, payers and care providers – have a role to play in activating change."

“Employers and employees want a fundamentally better health care experience, and these changes represent good first steps toward real-time prior authorization decisions. It’s critical that employers stay engaged and active in pushing for prior authorization improvements that deliver on our shared affordability and quality goals, with a particular focus on reducing friction for employees, their families, and clinicians,” said Shawn Gremminger, National Alliance of Healthcare Purchaser Coalitions President and CEO.

Reduction in scope

Participating health plans committed to making specific reductions to prior authorization as appropriate for the local markets each plan serves. Since making the commitments in June 2025, health plans have continued to evaluate their prior authorization requirements with the goal of speeding up patient access to appropriate care while maintaining important protections against waste, fraud and abuse. Providers’ continued engagement and support will be critical to delivering the full benefit of these commitments.  

A new AHIP-Blue Cross Blue Shield Association (BCBSA) survey of health plans participating in the commitments found that plans had achieved an 11% reduction across the markets covered by the commitments, including a reduction of more than 15% in Medicare Advantage. Services removed from prior authorization include those with clear, evidence-based clinical guidelines, demonstrated improvements in patient outcomes and consistent utilization patterns among providers. Prior authorization may still apply or be added to certain services based on evolving clinical guidance or recommendations.

Continuity of care

To ensure patients avoid disruptions in care, participating health plans will honor existing prior authorizations for benefit-equivalent, in-network services for a 90-day transition period. To support this commitment, many plans have established secure data-sharing processes to coordinate ongoing treatment and medications, along with enhanced customer service support to handle new continuity of care requests. This work serves as an important bridge ahead of new data sharing requirements, expanded use of electronic prior authorization (ePA) and progress toward real-time responses taking effect in 2027.

Enhanced communications

Participating health plans have also enhanced their communications on prior authorization determinations by using clear, consumer-friendly language and providing straightforward notices and determinations, including information on appeals processes and guidance on next steps. These improvements help patients and providers navigate coverage decisions more efficiently and with greater confidence.

Looking ahead

Participating health plans continue to advance two interrelated and transformational commitments related to standardizing ePA submissions and expanding real-time responses by January 1, 2027. These two commitments are a substantial technical and operational undertaking—needing strong partnership with care providers—and will ultimately enable fast, streamlined answers for most prior authorization requests at the point of care, giving providers and patients a faster and more consistent experience.

A list of participating health plans and additional information are available from AHIP and BCBSA.