One year after the Trump administration and dozens of insurers announced a six-part prior authorization reform pledge, some insurers now say they will not implement all of the promised steps, despite AHIP’s claim that plans eliminated 6.5 million prior authorizations — an 11% reduction. For clinicians, the practical takeaway is that prior auth delays, retroactive denials, and continuity-of-care gaps may still disrupt doctor-recommended treatment, including high-cost care such as cancer therapy.

The Move

• Several insurers that signed the June 2025 voluntary pledge to reduce prior authorization barriers are now backing away from parts of it, particularly a technology update tied to standardized electronic submissions.

• AHIP says participating plans have eliminated 6.5 million prior authorizations since the announcement, but it has not detailed which services were removed or how changes vary by insurer.

• The Trump administration announced the pledge with HHS Secretary Robert F. Kennedy Jr. and CMS officials, but no public dashboard or clear federal enforcement mechanism has emerged.

Why it Matters for Care

• Clinicians should expect that prior auth burdens may remain largely unchanged at the bedside, especially for complex, time-sensitive, or expensive care.

• Patients switching coverage may still face major continuity-of-care problems, including out-of-network bills and referral disputes, even when they believed ongoing specialty care would be protected.

• Preapproval still may not guarantee payment: insurers can later deny claims, leaving patients and practices exposed to retroactive denials, appeals, and financial toxicity.

Between the Lines

• Because the pledge is voluntary, critics say insurers retain strong financial incentives to preserve utilization controls unless rules, mandates, or reporting requirements force broader change.

• Insurers cite operational and privacy barriers, especially around sharing member data and building standardized electronic prior auth systems across plans.

• Bipartisan political pressure is rising after public anger over denials, but lawmakers and advocates remain skeptical that industry self-policing will meaningfully reduce friction in care delivery.

What to Watch

• Whether CMS or HHS creates the accountability measures floated last year, including public reporting dashboards or other oversight tools.

• Whether more insurers sign on to the April technology update before the Jan. 1, 2027, implementation target for standardized electronic prior authorization workflows.

• Whether Congress advances bipartisan prior auth legislation, including a House Ways and Means measure requiring Medicare Advantage plans to report prior auth items, denials, and grievances to the federal government.

Source: KFF Health News