U.S. Insurance Industry Trends: Notable Updates on Prior Authorization

In recent developments in the U.S. insurance industry, significant shifts are underway regarding prior authorization—a critical point of contention between providers, insurers, and patients. Central to these updates is UnitedHealthcare's goal to reduce prior authorization requirements by 10% in 2025, aiming to ease processes and reduce delays.

On the regulatory front, Rep. Mark Green of Tennessee has reintroduced legislation focused on streamlining prior authorization in Medicare, Medicare Advantage, and Part D programs, which may fundamentally alter how these processes are managed. Furthermore, state-level actions, especially by California and Hawaii, indicate a growing trend towards more structured and regulated approaches to prior authorization, particularly in how AI technologies are integrated into these systems.

Notable initiatives include California’s contemplation of specific AI regulations and Hawaii’s proposal requiring insurers to disclose prior authorization timelines and data. Commercially, new technologies like AI are being leveraged to execute prior authorizations autonomously, shown by MUSC Health's deployment of AI-enabled agents handling 40% of prior authorization tasks. These shifts highlight an industry grappling with technological advancements and regulatory changes, aiming to balance cost control with enhanced service delivery and patient care.