HHS, CMS, and Major Insurers Unite to Announce Voluntary Prior Authorization Reform Pledge

On June 23, 2025, US Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr and Centers for Medicare & Medicaid Services Administrator Mehmet Oz, MD, convened with industry leaders representing approximately 75% of insured Americans to advance a formal, industry-wide pledge aimed at overhauling the prior authorization (PA) process. 

"By January 2026, we’ll give the American people something they’ve been asking for—freedom from PA when used incorrectly,” said Dr Oz during the press conference. 

Health insurers pledged to uphold 6 key reforms: 

• Standardize electronic PA submissions using publicly accessible Fast Healthcare Interoperability Resources (FHIR®)-based application programming interfaces.
• Reduce the volume of medical services subject to PA by January 1, 2026.
• Honor existing authorizations during insurance transitions to ensure continuity of care.
• Enhance transparency and communication around authorization decisions and appeals.
• Expand real-time responses to minimize delays in care with real-time approvals for most requests by 2027.
• Ensure medical professionals review all clinical denials.

Companies represented at the roundtable discussion included Aetna, Inc., AHIP, BlueCross BlueShield Association, CareFirst BlueCross BlueShield, Centene Corporation, The Cigna Group, Elevance Health, GuideWell, Highmark Health, Humana, Inc., Kaiser Permanente, and UnitedHealthcare.

According to CMS Administrator Dr Oz, while the pledge is not a mandate or piece of legislation, it is an opportunity for industry leaders to step up and publicly pledge support for PA reform to the health care community and help to improve patient care.

CMS announced plans to publish a full list of participating insurance plans later this summer, along with specific details about their commitments under the pre-authorization reform pledge. These details will include measures like reduced code requirements and continuity of care protections, aiming to increase transparency and track real-world progress.

HHS representatives shared a goal to implement real-time decision-making for most electronic PA requests by 2027. Also discussed was an opportunity to improve PA by implementing the concept of exempting consistently high-performing “gold card” providers from routine PA requirements. 

“Thank you to the insurance companies for making these commitments today. Americans shouldn’t have to negotiate with their insurer to get the care they need,” said Secretary Kennedy Jr. “Pitting patients and their doctors against massive companies [is] not good for anyone. We are actively working with industry to make it easier to get PA for common services such as diagnostic imaging, physical therapy, and outpatient surgery.”

References

Sec. Kennedy, Admin. Oz Discuss Health Insurance Breakthrough. Presented at: HHS Press Conference; June 23, 2025; Washington, D.C. 

HHS Secretary Kennedy, CMS Administrator Oz secure industry pledge to fix broken prior Authorization System. News Release. HHS. Published June 23, 2025. Accessed June 23, 2025. https://www.hhs.gov/press-room/kennedy-oz-cms-secure-healthcare-industry-pledge-to-fix-prior-authorization-system.html