WASHINGTON, D.C. — In a significant move to address longstanding concerns over healthcare access and administrative burdens, major U.S. health insurers, including CVS Health, UnitedHealthcare, Cigna, and Humana, announced on June 23, 2025, a comprehensive initiative to streamline the prior authorization process across various insurance markets. This voluntary effort, coordinated by the trade group America’s Health Insurance Plans (AHIP), aims to simplify and modernize the system, enhancing patient access to necessary treatments and reducing delays in care.
Prior authorization, a process requiring healthcare providers to obtain approval from insurers before delivering certain medical services or prescriptions, has been criticized for causing treatment delays and adding administrative complexity. The new initiative seeks to address these issues by implementing standardized electronic processes, reducing the number of services requiring prior authorization, and ensuring that approvals remain valid even if patients change insurance plans.
The reforms are expected to benefit approximately 257 million Americans covered under commercial insurance, Medicaid managed care, and Medicare Advantage plans. AHIP CEO Mike Tuffin emphasized the importance of this initiative, stating, “The healthcare system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike. Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system.”
Key components of the initiative include:
- Developing standardized electronic data submission requirements by January 1, 2027.
- Reducing the number of procedures requiring prior authorization by January 1, 2026.
- Ensuring that prior authorizations remain valid for 90 days if patients switch providers or insurance plans.
The decision to reform the prior authorization process gained urgency following the December 2024 death of UnitedHealthcare CEO Brian Thompson, which brought heightened scrutiny to the system’s shortcomings. Public outcry over delays and denials of care underscored the need for change, prompting insurers to take action.
U.S. Health Secretary Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz played pivotal roles in facilitating the agreement. At a press conference, Dr. Oz highlighted the significance of the reforms, stating, “This initiative represents a critical step toward reducing administrative burdens and improving patient care. If insurers fail to honor their commitments, we will consider regulatory measures to ensure accountability.”
While the reforms are voluntary, they align with broader efforts by CMS to enhance efficiency and transparency in healthcare delivery. CMS has been exploring proposals to limit the use of prior authorizations and promote automation in coverage determinations, aiming to cut down on unnecessary delays for patients seeking medical care.
Industry experts and healthcare providers have expressed cautious optimism about the initiative. Kaye Pestaina, an expert on consumer protection at the Kaiser Family Foundation, noted, “Reducing the scope of services requiring prior authorization is a positive development. However, measuring the impact will be crucial to ensure that patients truly benefit from these changes.”
The reforms are anticipated to alleviate administrative burdens on healthcare providers, allowing them to dedicate more time to patient care. By streamlining the prior authorization process, insurers aim to enhance patient satisfaction and contribute to a more efficient healthcare system.
As the healthcare landscape continues to evolve, the success of this initiative will depend on the commitment of insurers to implement the proposed changes effectively. Stakeholders will be closely monitoring progress to ensure that the reforms translate into tangible improvements in patient access to care.
