As payers tout progress made under a pledge to ease burdens around prior authorizations, physicians remain skeptical, a new survey shows.
The American Medical Association released the results from a poll conducted in December 2025 of 1,000 physicians on their experiences with prior authorization. Only a third (33%) of those surveyed said they believe that the payers' pledge last summer would lead to significant change.
One of the key sources of that skepticism, per the survey, is physicians' first-hand interactions with health plans' representatives. Just 24% of the surveyed docs said that prior authorization reviews are conducted consistently by qualified clinicians.
Similarly, 16% said that, in peer-to-peer reviews, they find the insurer representatives either often or always have the necessary credentials, according to the survey.
“Physician trust in voluntary insurer pledges is deeply eroded after years of unfulfilled promises,” said AMA President Bobby Mukkamala, M.D., in a press release.
"Rebuilding trust will require sustained, transparent and measurable action to streamline prior authorization and keep it clinically focused and patient-centered," Mukkamala continued. "Anything less risks reinforcing the skepticism these pledges were meant to address."
In June 2025, the leading insurance organizations (AHIP and the Blue Cross Blue Shield Association), all six of the largest, publicly traded payer firms and many other payers signed on to a pledge to reduce the number of services subject to prior authorization as well as take steps to promote electronic prior auth submissions, which can significantly accelerate response times.
In April, AHIP and BCBSA released a report that said payers have reduced prior auths by 11% under the pledge.
Per the AMA survey, physicians say the major insurers all put a consistently high burden on them due to prior authorization, with them ranking UnitedHealthcare at the highest. Docs said they complete 40 prior authorization requests each week on average, with 32% saying these submissions are often or always denied.
Most (94%) said this administrative burden contributes to physician burnout.
In addition, the surveyed docs said they've seen denial rates increasing. Seventy-four percent said denial rates have gone up over the past several years, and 60% said they're concerned AI may be worsening this trend.
The survey also found confusion on when prior auth requests are necessary, and lacking technology to adapt to more electronic submissions. A majority (63%) said it is difficult to tell whether a medication requires authorization, with 62% saying the same about medical services.
More than a quarter (27%) said that information about requirements that's provided through their electronic health record or e-prescribing platform is rarely or never accurate.
Phone calls were named as the most common way for physicians to complete prior auth requests for medical services. Just 24% said they can use their EHR to submit electronic requests for medications, according to the survey.
As part of the insurer pledge, payers said they will standardize electronic prior authorization and increase the number of response made in real time. And as of this week, some health systems, EHR vendors and data platforms are also all-in on streamlining prior auth.