CVS Health’s Aetna and Blue Cross Blue Shield Among Insurers Pledging to Reform Criticized Prior Authorization Process
Health insurers are set to unveil a new industry-wide initiative aimed at easing the administrative burden and care delays caused by prior authorization (PA), a longstanding source of frustration for clinicians and patients, according to a report by The Wall Street Journal. The plan, which will be discussed in a press conference with US Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr and Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz, MD, outlines a series of commitments from major insurers to improve and streamline the preapproval process by 2027.
Central to the initiative is a pledge to create a standardized format for electronic PA requests and to provide real-time responses to 80% of those submissions—if complete documentation is provided. Insurers will also aim to reduce the number of services requiring PA, though no specific numerical targets have been set.
“Excessive and overly burdensome prior authorization requirements create barriers to care for patients and contribute to burning out our health care work force,” said American Hospital Association Chief Executive Rick Pollack. “We appreciate that plans acknowledge this, and we look forward to reviewing the details of how they intend to improve upon these processes and stand ready to support meaningful improvements.”
Critics argue that PA often serves as a barrier to medically necessary care and contributes to provider burnout.
As part of the initiative, insurers will commit to providing clearer explanations for prior authorization decisions, including detailed reasoning for denials. They will also improve guidance on how patients can appeal those decisions, aiming to make the process more understandable and accessible. Another feature of the reform plan includes a temporary 90-day PA waiver for patients switching insurance plans. All denials will continue to be reviewed by medical professionals, with insurers reserving a role for artificial intelligence in support functions.
While individual insurers such as CVS Health’s Aetna and Cigna have previously introduced their own reforms, this new initiative represents a coordinated effort across the industry. However, questions remain about whether these changes will sufficiently address concerns from clinicians and patients about access to timely, necessary care.
Reference
Mathews AW. Health insurers to promise changes to preapproval process that drew backlash. WSJ. Published June 20, 2025. Accessed June 23, 2025. https://www.wsj.com/health/healthcare/health-insurers-to-promise-changes-to-preapproval-process-that-drew-backlash-26100698?st=qZh3QX&reflink=article_email_share
