Leading health insurers report an 11% reduction in prior authorization volume, representing approximately 6.5 million fewer requests since mid-2025. Medicare Advantage plans saw a larger reduction of 15%, reflecting targeted efforts within government-sponsored programs.

The changes stem from a 2025 industry pledge led by AHIP and the Blue Cross Blue Shield Association, with participation from approximately 50 health plans.
Participating organizations include major national payers such as Cigna, Humana, and UnitedHealthcare.

Reforms have focused on removing prior authorization requirements for services with established clinical guidelines and predictable utilization patterns. Additional updates include clearer patient communication and more transparent processes for denials and appeals.

The initiative is supported in part by the Centers for Medicare & Medicaid Services and the U.S. Department of Health and Human Services, with continued emphasis on modernization.

Payers are also advancing electronic prior authorization capabilities, with a goal of enabling real-time processing and standardized workflows by January 1, 2027.

The reduction signals early movement toward lowering administrative burden, though provider impact remains mixed amid ongoing concerns around claims denials and revenue performance.

Source: Fierce Healthcare | Paige Minemyer