A coalition of major U.S. health insurers has pledged to overhaul the often-criticized prior authorization process, committing to reducing administrative delays and improving access to care for more than 250 million Americans enrolled in commercial, Medicare Advantage, and Medicaid managed care plans.
Unveiled on June 23 by the trade association AHIP and the Blue Cross Blue Shield Association, the initiative introduces a set of industry-wide commitments aimed at modernizing and streamlining how insurers review and approve medical treatments and services. The reforms focus on improving timeliness, enhancing transparency, and adopting advanced technologies to ease burdens on patients and providers alike.
Prior authorization, a tool used by insurers to verify that treatments and prescriptions are medically appropriate and supported by clinical guidelines, is intended to prevent unnecessary, duplicative, or potentially harmful care. According to an AHIP report, roughly 25 percent of U.S. health care spending is considered wasteful—driven by overtreatment, inefficiency, and lack of care coordination. Patients and health care professionals have long criticized the prior authorization process for causing delays and confusion, especially when insurers rely on outdated manual systems….