More than 60 insurers pledge to simplify prior authorization

On June 23, 2025, the Department of Health and Human Services and the Centers for Medicare & Medicaid Services announced that a large share of the insurance industry had signed a voluntary pledge to simplify prior authorization — the approval step insurers require before they will pay for certain care. HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz convened the effort at a June 2025 roundtable with industry leaders ^[1]. The trade groups AHIP and the Blue Cross Blue Shield Association announced the commitments, and more than 60 health insurers had signed on ^[3].

The pledge includes six commitments with staggered deadlines ^[3]. Three took effect January 1, 2026: individually reducing the volume of in-network medical prior authorizations "as appropriate for the local market each health plan serves"; honoring a previous plan's prior authorization for the same in-network service for a 90-day transition period when someone switches plans mid-treatment; and giving clearer, personalized explanations of denials, including next steps and appeal options ^[3]. A fourth commitment — that denials based on medical necessity be reviewed by a licensed, qualified clinician — was described as already existing practice and in effect at the time of the announcement ^[2][3].

Two bigger technical commitments carry a January 1, 2027 goal date. Plans said they will standardize electronic prior authorization using FHIR-based application programming interfaces, and that for all coverage types, at least 80% of prior authorization approvals submitted electronically with all necessary clinical documentation will be answered in real time ^[3]. AHIP says health plans covering nearly 270 million Americans are participating, across commercial coverage, Medicare Advantage and Medicaid managed care ^[2].

The scale of the paperwork problem is large. CMS estimates that requesting prior authorizations costs providers $20–50 per hour and takes an average of 13 hours per week — roughly $34,000 and 700 hours of administrative time per provider each year ^[1]. AHIP says nearly half of prior authorization requests are still submitted by fax or phone ^[2]. Separately, certain CMS-regulated health plans are already required to implement the new APIs starting January 1, 2027 under federal rules ^[1].

The drug-benefit gap

For people taking or considering GLP-1 medicines, one detail matters most: the American Medical Association noted that the health plans' proposals "do not address prior authorization in prescription-drug benefits, are limited to certain health-plan products, and reflect just a subset" of the reforms the AMA has sought ^[3]. Coverage decisions for drugs such as semaglutide (Ozempic, Wegovy, Rybelsus) and tirzepatide (Mounjaro, Zepbound) typically run through the pharmacy benefit, which this pledge does not directly cover based on the sources available.

AMA President Bobby Mukkamala, MD, said the announced changes "would help right-size and streamline a process that is harming our patients daily," while also warning that "despite widespread calls for meaningful reforms and the insurance industry's past promises, the prior authorization process remains costly, inefficient, opaque, and too often hazardous for patients" ^[3]. The AMA said it would monitor implementation closely ^[3].

Why it matters for patients

The commitments are voluntary, not law. The AMA points out that several pledged actions — such as standardized electronic prior authorization and better communication on denials — are mirrored in recent CMS final rules, which gives CMS authority to enforce follow-through for federally regulated plans ^[3]. Outside those rules, enforcement depends on each plan.

The most immediately usable piece for many people is the 90-day continuity provision: if you change insurers mid-treatment, the new plan is supposed to honor the old plan's prior authorization for a benefit-equivalent in-network service during a 90-day transition ^[2][3]. Whether that extends to a medication depends on the plan's benefit design, and the sources do not spell out how it applies to specific drugs. Real-time approvals also depend on providers moving off fax and phone workflows, which AHIP acknowledges will require meaningful change ^[2].

What happens next

AHIP and BCBSA said they would publish the first of regular updates on industry-wide implementation in spring 2026, with an update on the 2027 technical commitments later that year ^[2]. CMS has also listed a 2026 Interoperability Standards and Prior Authorization for Drugs proposed rule, released April 10, 2026, which would extend reforms toward drug coverage ^[1]. Final results for the 80% real-time target are not yet known.