US Health Insurers Pledge to Simplify Prior Authorization by 2027

In response to growing frustrations over the prior authorization (PA) process, several major U.S. health insurers have committed to reforms aimed at simplifying and expediting preapproval protocols. These insurers cover approximately 257 million Americans across commercial, Medicare Advantage, and Medicaid-managed care plans. The initiative seeks to enhance patient access to medically appropriate treatments while reducing administrative burdens on providers.

Key commitments include developing a standardized electronic prior authorization system targeted for implementation by January 1, 2027, which promises faster decision-making and increased transparency. Additionally, insurers plan to reduce the volume of services requiring preapproval starting in early 2025 and to recognize existing prior authorizations for 90 days when patients switch insurance plans during ongoing treatment.

The insurers also pledge clearer communication about authorization decisions, including detailed explanations and appeal processes, initially for commercial plans with intentions to extend these improvements to Medicare and Medicaid products. Real-time electronic approvals are expected to reach at least 80% by 2027, provided clinicians submit complete documentation, with all denials reviewed by medical professionals to ensure clinical appropriateness.

This collaborative effort involves leading carriers such as UnitedHealthcare, Aetna, Cigna, Humana, Elevance Health, Kaiser Permanente, and numerous Blue Cross Blue Shield entities. Some insurers had begun adopting similar initiatives independently, like UnitedHealthcare's focus on Medicare Advantage streamlining, and Cigna's patient concierge teams to assist with authorization challenges.

These reforms follow heightened attention on care denial controversies stemming from a high-profile executive's fatal shooting last year, which spotlighted patient and provider frustrations with prior authorization delays. Federal health officials plan to discuss the initiative further, indicating significant regulatory interest in these insurer-led operational improvements.

The changes aim to balance insurer responsibilities to ensure safe, evidence-based care with reducing procedural roadblocks that can delay necessary medical services. This industry-wide commitment marks a notable step toward addressing long-standing claims processing inefficiencies and enhancing the patient and provider experience within U.S. health insurance systems.