Insurers large and small from across the country have announced a series of commitments they're making to reform one of the biggest pain points in the patient journey: prior authorization.
Key steps include committing to reducing the number of services that are subject to prior auth, with "demonstrated" progress by Jan. 1, 2026. The plans are also working to roll out common and transparent solutions that promote electronic prior auth submissions, with a framework up and running for plans and providers by Jan. 1, 2027.
About 50 insurers have signed on to the pledge including all six of the largest, publicly traded health plans: Elevance Health, Centene, Cigna, CVS Health's Aetna, Humana and UnitedHealthcare. A slew of Blue Cross Blue Shield plans are also leading the charge, and the initiative is backed by both AHIP and the Blue Cross Blue Shield Association.
The announcement says the commitment stretches across various insurance markets, including commercial plans, Medicare Advantage and Medicaid managed care. The enhancements to prior auth practices are set to reach 257 million Americans.
"The healthcare system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike," AHIP CEO Mike Tuffin said in the announcement. "Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system."
Insurance industry practices like prior auth have faced increased scrutiny following the murder of former UnitedHealthcare CEO Brian Thompson in December. In the wake of Thompson's death, many took to social media to voice their frustrations with common challenges like claims denials, prior auth and provider networks.
The insurers also said they would improve transparency and communication around determinations. Patients will be offered explanations for determinations that are clear and easy for them to understand along with directions to appeals and other next steps if needed.
They plan to have these in place by Jan. 1, 2026, in the fully insured and commercial markets, while pushing for regulatory changes that allow insurers to be similarly transparent within other types of coverage, according to the announcement.
Other commitments include growing the number of responses that are answered in real time, saying that by 2027, 80% of electronic prior auth requests will be completed in real time. They also reaffirmed that denials that cite a clinical reason will be reviewed by medical professionals, a "standard already in place," according to the announcement.
In addition, the insurers aim to preserve continuity of care. Should a patient switch plans while undergoing a course of treatment, they agreed to uphold existing prior authorizations for equivalent in-network services as part of a 90-day transition period for the member.
The announcement also said progress toward these goals will be tracked and reported to hold the insurers accountable.
Shawn Martin, executive vice president and CEO of the American Academy of Family Physicians, said in the release that the organization is "encouraged" by the pledges made by the health plans.
"While this commitment is a step in the right direction, we will ultimately measure its impact by real changes in the day-to-day experiences of patients and the physicians who care for them," Martin said. "We look forward to collaborating with payers to ensure these efforts lead to meaningful and lasting improvements in patient care."