Major health plans pledge to simplify prior authorizations

U.S. health plans have voluntarily committed to improving the prior authorization process across the industry, AHIP announced. UnitedHealthcare, Humana, Cigna and CVS Health were among the dozens of major insurers to sign the agreement.

The prior authorization process has faced scrutiny due to the high administrative burden it creates. Many surveyed physicians have reported care delays and treatment abandonment as a result of prior authorizations.

In its June 23, 2025, announcement, AHIP acknowledged the importance of connecting patients to care while reducing administrative burdens.

"The healthcare system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike," said AHIP President and CEO Mike Tuffin.

"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."

Participating health plans agreed to six actions to streamline the prior authorization process.

First, the health plans committed to standardizing electronic prior authorization by developing standardized data and submission requirements using FHIR application programming interfaces (APIs). These standards are expected to be available to plans and providers by Jan. 1, 2027.

Second, health plans agreed to deliver demonstrated reductions to medical prior authorization (as applicable for each plan's local market) by Jan. 1, 2026.

Also starting Jan. 1, 2026, it will be easier for patients to switch plans without disrupting care. When a patient changes insurance companies during treatment, the new plan will have to honor existing prior authorizations during a 90-day transition period.

Health plans will also begin providing clear explanations of prior authorization determinations, including guidance for appeals, in an effort to make these determinations easier for patients to understand.

Additionally, the participating health plans agreed to ensure that at least 80% of electronic prior authorization approvals will be answered in real-time by 2027. The adoption of FHIR APIs will speed up real-time responses further, the announcement noted.

Lastly, participating plans doubled down on a prior commitment: all requests that were not approved based on clinical reasons will continue to be reviewed by medical professionals.

The six commitments will be implemented across the health insurance market, including commercial coverage, Medicare Advantage and Medicaid managed care. AHIP estimated that the changes would benefit 257 million Americans.

"We are encouraged by this collective commitment to reform prior authorization practices. Physicians have long advocated for reforms that help ensure that patients receive timely, medically necessary care and reduce administrative burden -- including the elimination of unnecessary prior authorizations," said Shawn Martin, executive vice president and CEO of the American Academy of Family Physicians, said in the announcement.

"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. We look forward to collaborating with payers to ensure these efforts lead to meaningful and lasting improvements in patient care."

AHIP said that progress on these initiatives will be tracked and reported.

Jill McKeon has covered healthcare cybersecurity and privacy news since 2021.