Health insurers promise reforms to prior authorization process
- Health insurers have committed to reforming the prior authorization process to alleviate delays in patient care.
- New policies will include honoring existing prior authorizations during insurance switches and providing clearer explanations for denials.
- Despite these assurances, skepticism remains regarding the successful implementation of these changes.
In the United States, on June 23, 2025, health insurers, including the Blue Cross Blue Shield Association and America's Health Insurance Plans (AHIP), committed to reform the frequently criticized prior authorization process. This announcement was made by Health and Human Services Secretary Robert F. Kennedy Jr. at a media event, highlighting the industry's past failures to implement similar reforms. Prior authorization has been a significant barrier to patient access to care, often leading to delays or denials. Notably, a survey indicated that approximately one in six insured adults has encountered prior authorization issues, intensifying the focus on the need for change. The commitments outlined by AHIP include honoring prior authorizations for up to 90 days when a patient switches insurance providers while undergoing treatment. Additionally, insurers will provide more transparent explanations for denial of authorizations and enhance procedures for appeals. The plan also involves ensuring that medical professionals review all authorization denials, a practice that insurers claim to currently follow. Furthermore, by 2027, streamlining the submission process for prior authorization requests will occur, which is expected to ease the burdens on healthcare providers and patients these requirements impose. Despite these commitments, skepticism persists regarding the willingness of health insurers to follow through on their promises. Critiques from experts suggest that the industry has historically failed to adopt necessary reforms despite previous pledges. The shooting of Brian Thompson, the CEO of UnitedHealth’s insurance arm, has acted as a catalyst for renewed attention on the impacts of prior authorization delays on patient care. AHIP’s changes are poised to affect an estimated 257 million Americans, yet the viability of such reforms remains to be seen. In conclusion, the new proposals from major health insurance providers reflect an industry responding to increasing pressure for accountability and change in the prior authorization process. However, only time will reveal whether these initiatives will meaningfully improve patients' access to timely medical care, as many advocates express doubts about the sincerity and effectiveness of these commitments.