The insurers aim to implement some of these changes as early as January 2026.

The American Health Insurance Plans trade group issued a press release on June 23, 2025, announcing that certain U.S. health insurers have agreed to streamline the prior authorization process. The insurers who have agreed to this new process include some of the largest health insurers in the country: CVS Health (Aetna), UnitedHealthcare, Cigna, Humana, Elevance Health and Blue Cross Blue Shield. The changes will apply both to commercial plans and certain Medicaid and Medicare plans.

Prior authorization is the process through which a health insurer requires approval before allowing a provider to carry out certain services or treatments. Some providers are overwhelmed by the volume of prior authorizations required by insurance companies in order to provide effective treatment to their patients, which can lead to ineffective treatment or simply the inability for individuals to receive necessary treatment at all.

Prior authorization has additionally been blamed for the delay or denial of necessary medical care. An American Medical Association survey found that 93 percent of physicians believe prior authorizations lead to the delay of necessary care and 24 percent reported that a prior authorization has led to a serious adverse event for a patient, including hospitalization. Health insurers state that prior authorizations are a necessary tool to control costs and ensure the care patients receive is medically necessary.

For providers, these changes could create a more efficient and transparent process. Some of the changes health plans intend to make include:

• Implementing a common electronic prior authorization submission process.
• Reducing the scope of claims subject to prior authorization.
• Honoring existing prior authorizations from other health plans when a patient changes insurance companies.
• Providing clearer communications to patients regarding prior authorizations, including support for appeals.
• Providing a real-time response for at least 80 percent of prior authorizations.
• Ensuring a medical professional reviews all prior authorizations denied based on clinical reasons.

The insurers aim to implement some of these changes as early as January 2026.

This change is particularly welcomed by independent providers, including pharmacies, following on the heels of ongoing state and federal government scrutiny of pharmacy benefit managers (PBMs). PBMs serve as middlemen between pharmacies and the insurance companies to facilitate pharmacy networks and reimburse pharmacies for medications dispensed to insureds. And the major PBMs are owned by the largest insurance companies in the U.S.

Similar to insurance companies, PBMs also require prior authorizations for the use of certain medications. And many PBMs prohibit the pharmacies dispensing medications to insureds from requesting a prior authorization, instead requiring the prescribing physicians to do so, leading to ever further delays. PBMs have been criticized for their outsized control over prior authorizations. For example, a recent interim report issued by the Federal Trade Commission in its ongoing 6(b) study of the PBM market states that evidence shows that PBMs “enter agreements that require prior authorization… to discourage patients’ utilization of generic drugs.” And, in a recent report on “The Role of Pharmacy Benefit Managers in Prescription Drug Markets,” the House Oversight Committee finds that prior authorizations “can harm patients by restricting necessary care unless the patient can pay for the prescription out of pocket” and noting that “lengthy delays for prior authorizations can cause suffering or even death as patients wait for PBMs to approve life-saving medications their doctors prescribe.”

While prior authorizations are instituted to ensure treatment is medically necessary, it is clear that health insurers are beginning to heed the call for reform to prioritize the improvement of patient care over profits. In light of the increased scrutiny on PBMs that also similarly require the streamlining of patient treatment, we will continue to monitor developments in this area and report on improvements to the PBM prior authorization process as well.

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