On Monday, the Blue Cross Blue Shield Association, AHIP—a trade organization representing insurers—and 48 carriers announced a plan to reduce the administrative challenges of prior authorization over the next two years. The group pledged to decrease the total number of prior authorization requests, standardize and improve response times, and enhance coordination with healthcare providers regarding the process.
This is not the first time such promises have been made. In 2018, insurers agreed to ease prior authorization requirements by signing a consensus statement with organizations including the AMA, American Hospital Association, Medical Group Management Association, and pharmacist trade groups. Despite these commitments, survey data from the AMA has continued to indicate that physicians see prior authorization as a significant obstacle to patient care.
By 2022, the AMA acknowledged that “Insurance companies are not following through with agreed upon prior authorization reform,” citing ongoing negative feedback from physicians in their surveys. Recent survey results continue to show that physicians encounter substantial problems related to prior authorization without clear signs of improvement.
U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz, MD, expressed optimism about this new effort. According to Modern Healthcare, Dr. Oz stated: “There’s violence in the streets over these issues” and “Americans are upset about it.” He attributed his optimism to greater insurer participation this time around, increased public frustration over prior authorization practices, and insurers’ focus on interoperability.
The Florida Medical Association (FMA) has stated its intent to ensure that this renewed commitment does not serve as an excuse for carriers to avoid reasonable legislative or regulatory measures—such as setting deadlines for responses or banning retroactive denials. The FMA noted skepticism about whether insurers will self-regulate adequately without legislative action but emphasized its role in advocating for protections for patients.
