Insurers large and small from across the country have announced a series of commitments they are making to reform one of the biggest pain points in the patient journey: prior authorization. Prior authorization, also known as pre-authorization or precertification, is a process where a health insurance plan requires a healthcare provider to obtain approval before providing certain medical services or medications to a patient. This process helps the insurer determine if the requested service or medication is medically necessary and covered under the patient’s plan. In short, prior authorization is a mechanism used by health insurance companies to manage costs and ensure the appropriateness of healthcare services, but it can also create challenges for patients and providers.
Key steps in the reform include committing to reducing the number of services that are subject to prior authorization, with “demonstrated” progress by January 1, 2026. The plans are also working to roll out common and transparent solutions that promote electronic prior authorization submissions with a framework up and running for plans and providers by January 1, 2027.
About 50 insurers have signed on to the pledge including all six of the largest publicly traded health plans including: Elevance Health, Centene, Cigna, CVS Health’s Aetna, Humana and UnitedHealthcare. A slew of Blue Cross Blue Shield plans are also leading the charge and the initiative is backed by both AHIP and the Blue Cross Blue Shield Association. This reform could be extremely beneficial to patients in their healthcare journey.
Reference: AHIP Solutions Smart Brief June 2025