New Initiative Aims to Cut Red Tape in Prior Authorization

U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. announced that the nation’s largest health insurers have agreed to streamline, simplify, and standardize the prior authorization process.

Prior authorization requires physicians to obtain insurer approval before providing certain medications or treatments. While intended to control costs, this process can create delays and barriers to care for patients and providers.

U.S. Centers for Medicare and Medicaid Services Administrator Mehmet Oz shared that only about half of the 6,000 annual procedures requiring prior authorization should actually need it.

Nearly 50 health insurers, including Blue Cross Blue Shield Association, Cigna, Elevance Health, Humana, and UnitedHealthcare, have pledged to improve the prior authorization process. HHS outlined six key parts of this pledge:

1. Implement a unified system for electronic prior authorization submissions.
2. Limit prior authorization requirements to fewer medical services.
3. Maintain prior authorizations when patients switch insurance during treatment.
4. Increase transparency and clarity for authorization decisions and appeals.
5. Minimize delays with real-time approvals for most requests.
6. Require medical professionals to review all clinical denials.

These updates will apply across insurance marketings, including private insurance, Medicare Advantage, and Medicaid plans.

What’s Next?

This pledge seeks to reduce administrative hurdles, speed up care decisions, and improve transparency. Insurers plan to standardize electronic submissions by January 2027, narrow prior authorization requirements by January 2026, and honor 90-day approvals when coverage changes mid-treatment. These are commitments—not mandates—so employers should monitor evolving requirements. Most U.S. patients are covered; CMS will release a full list of participating plans soon. Download the bulletin for more details.