Health insurance plans accounting for coverage of 260 million individuals pledged a commitment to streamline prior authorization by voluntarily agreeing to new standards. Industry leaders on June 20 agreed to implement a standardized electronic authorization form for all prior authorization requests by 2027. Health plans will also maintain an 80% approval rate of prior authorization requests in real time, meaning that providers would be able to submit a prior authorization request through their electronic health record and receive a decision back within minutes. By 2026, insurers will aim to reduce the number of codes subject to prior authorization requests. Insurers will also commit to honoring a previous health plan’s prior authorization during a 90-day transition period when a member changes health plans after starting a course of treatment. The commitment also ensures that prior authorization denials based on medical necessity will be reviewed by a licensed and qualified clinician.
In addition to this announcement, Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services Administrator Mehmet Oz, MD, held a roundtable event highlighting the commitments made by U.S. health plans. During the event, Oz applauded these commitments and underscored the agency’s willingness to pursue regulatory action to streamline prior authorizations, noting, “CMS will be evaluating progress and driving accountability toward our shared goals, as we continue to champion solutions that put patients first.”