Health Insurers Agree to Overhaul Prior Authorization System

In a significant move to address a major healthcare issue, HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz announced a landmark agreement with major health insurers to overhaul the prior authorization process, which has been a major barrier to care for millions of Americans. Prior authorization, requiring advance approval from insurance companies for certain treatments, was intended to control costs but has become a significant obstacle for 85% of Americans. In 2023, Medicare Advantage denied 3.2 million prior authorization requests, often for urgent, life-saving care. Doctors spend an average of 12 hours weekly on prior authorization paperwork, contributing to burnout and delayed treatment. The agreement, covering nearly 80% of Americans, includes six key reforms: standardizing electronic submissions, reducing services requiring approval by 2026, honoring authorizations during plan changes, improving transparency, expanding real-time decisions by 2027, and ensuring clinical denials are reviewed by medical professionals. Eric Dane, an actor and ALS patient, highlighted the stress caused by prior authorization, emphasizing the need for timely care. The insurers have committed to clear metrics, deadlines, and CMS oversight to ensure compliance, marking a significant shift in tackling this issue. Kennedy called the agreement a "monumental accomplishment," noting it as a long-overdue fix for a broken system. This reform aims to restore trust, ease provider burdens, and ensure patients receive timely, evidence-based care.

Published: 6/24/2025