Prior authorization remains a longstanding barrier to timely care. The current process often results in treatment delays for services such as diagnostic imaging, outpatient procedures, and rehabilitative therapies. For providers, prior auth contributes to a significant volume of administrative overhead. According to the American Medical Association, 94% of physicians report that prior authorization leads to care delays, and 80% say it can lead patients to abandon treatment altogether.

As part of the initiative, participating insurers (including Aetna, AHIP, Blue Cross Blue Shield, Centene, Cigna, Humana, Kaiser Permanente, UnitedHealthcare, and others) have pledged to implement the following reforms:

1. Standardize electronic prior authorization submissions using FHIR®-based APIs.
2. Remove prior authorization requirements for many routinely approved services by January 1, 2026.
3. Honor existing prior authorizations when patients switch health plans.
4. Improve transparency in approval and denial communications, including appeals.
5. Implement real-time prior authorization decisions by 2027.
6. Ensure that denial decisions are reviewed by qualified clinicians, not administrative staff.

The CMS press release outlining the initiative emphasized a shared commitment to regulatory alignment, reduced administrative complexity, and improved patient outcomes. HHS officials noted that while the reforms are voluntary, CMS will monitor implementation and may consider future regulatory action if progress lags.

The policy announcement has drawn bipartisan support. Sen. Roger Marshall (R–KS), a practicing OB-GYN before joining Congress, called the initiative “long overdue.” Rep. Greg Murphy (R–NC), a urologist, echoed the sentiment, citing prior authorization as a persistent obstacle to patient care.