HHS promotes insurer pledge to scale back prior authorization

The Hill ^ | 6/23/25 | Joseph Choi

[CFW]

Federal health officials on Monday touted pledges they have received from the health insurance industry to streamline and reform the prior authorization process for Medicare Advantage, Medicaid Managed Care and Affordable Care Act Health Insurance Marketplace plans which account for most insured Americans.

Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services Administrator Mehmet Oz took part in a roundtable discussion with insurers in which the payers pledged commitments to six key reforms to the prior authorization process.

Health care providers must obtain approval from an insurer before a specific service is covered, and they’ve criticized that process for being time-consuming and a drag on providing health care.

According to Oz, the roundtable included the CEOs of health insurance companies who cover about 75 percent of Americans. The CMS administrator said he would like fewer services to be subject to preauthorization.

[CFW]

It's a start.

Here is the press release:

Prior authorization pledges"

[GaryCrow]

Prior authorizations are the insurance company's way of making the process arduous in the hopes that you'll get frustrated and decide to not have the procedure or opt to not pursue the medication (many expensive medications require prior authorizations too).

I wish prior authorizations were outlawed all together, it should be the physician's determination who needs surgery or medication, not some insurance lackey. I wish the whole insurance industry would be outlawed, the whole thing is a scam designed to suck money out of people that provides no benefit but takes a huge portion of the money.

[Brian Griffin]

Participating health insurers have pledged to:

Standardize electronic prior authorization submissions using Fast Healthcare Interoperability Resources (FHIR®)-based application programming interfaces.

Reduce the volume of medical services subject to prior authorization by January 1, 2026.

Honor existing authorizations during insurance transitions to ensure continuity of care.

Enhance transparency and communication around authorization decisions and appeals.

Expand real-time responses to minimize delays in care with real-time approvals for most requests by 2027.

Ensure medical professionals review all clinical denials.