Insurers have Cut Prior Auth by 11% Following Commitments Leave a comment

In June of 2025, health plans made a series of commitments to improve prior authorization. On Tuesday, insurer advocacy organization AHIP and Blue Cross Blue Shield Association gave their first update, announcing that health plans have eliminated 11% of prior authorizations since making the commitments. 

This represents 6.5 million fewer prior authorizations. In Medicare Advantage, prior authorizations are down 15%.

“Health plans have taken important initial steps to support patients and are working toward the shared goal of delivering answers at the point of care whenever possible—a goal that will require both plans and providers to eliminate manual processes and adopt real-time electronic data sharing,” said Mike Tuffin, AHIP president and CEO.

The multi-year commitments are in partnership with the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services. Several of the commitments went into effect in January, while others will go into effect in 2027. The 2026 commitments include:

• Reducing the scope of claims subject to prior authorization: Insurers are reducing prior authorization requirements for certain claims, which depend on the market each plan serves. The services removed from prior authorization requirements include those with evidence-based guidelines and demonstrated improvements in outcomes, according to the Tuesday announcement.
• Ensuring continuity of care when patients switch plans: When patients switch insurance plans during treatment, their new insurer must honor existing prior authorizations for similar in-network services for 90 days to ensure continuity of care and prevent delays. For this commitment, many plans have created secure data-sharing processes to coordinate ongoing treatment, AHIP and BCBSA said.
• Improving communication and transparency on determinations: The insurers pledged to give clear explanations of prior authorization determinations, as well as information on appeals. This became available for fully insured and commercial coverage in January. To improve communication, payers have implemented “consumer-friendly language” and provided “straightforward notices and determinations.”

In 2027, payers are focusing on standardizing electronic prior authorization and expanding real-time responses. 

“Moving forward, we will focus on our commitment to address 80% of electronic prior authorization requests in real-time, at the speed of care. We share CMS’ urgency to modernize the infrastructure of health care and understand that all of us – policymakers, payers and care providers – have a role to play in activating change,” said Kim Keck, CEO of the Blue Cross Blue Shield Association.

One employer advocate called the changes “good first steps toward real-time prior authorization decisions.”

“It’s critical that employers stay engaged and active in pushing for prior authorization improvements that deliver on our shared affordability and quality goals, with a particular focus on reducing friction for employees, their families, and clinicians,” said Shawn Gremminger, president and CEO of the National Alliance of Healthcare Purchaser Coalitions.

Families USA, a patient advocacy organization, said it appreciates the steps to improve prior authorization, but more action is needed.
“Voluntary commitments acknowledge the problem, but they are not a substitute for a solution in statute, with enforceable standards and accountability,” said Anthony Wright, executive director of the organization. “Lasting change requires clear consumer protections, legislative action, and strong oversight to ensure that patients get the care they need regardless of how they are insured.”

Photo: Piotrekswat, Getty Images