Insurance industry boasts 11% reduction in prior authorizations since 2025 reform rollout
Health plans have successfully reduced the number of prior authorizations by millions, after making multi-year commitments with the U.S. Department of Health and Human Services (HHS) to do so as part of a reform initiative that began in June 2025.
Since that time, major insurers have reduced prior authorizations—the process by which patient care plans are submitted for approval in advance to ensure reimbursement—by 11%, a survey conducted by AHIP revealed.
Homing in on Medicare Advantage plans, often associated with patient care delays stemming from prior authorizations, the researchers found the reduction rate rises to 15%.
Many common patient care services have been removed from the list of procedures that require providers to seek approval, AHIP said, so long as there are “evidence-based clinical guidelines” that show a measurable improvement in patient outcomes.
AHIP, a lobby and professional organization for the medical insurance industry, was quick to note that despite the reductions to date, new prior authorization barriers may be added to “certain services” in the future as clinical evidence changes and costs rise.
As for the totality of prior authorizations eliminated as part of this ongoing effort by insurers to reduce the burden on patients and providers, the survey results show that it equates to 6.5 million nationwide.
“Health plans have taken important initial steps to support patients and are working toward the shared goal of delivering answers at the point of care whenever possible—a goal that will require both plans and providers to eliminate manual processes and adopt real-time electronic data sharing,” Mike Tuffin, AHIP President and CEO, said in a statement.
He is referring to the specifics of this industry-wide plan to make reductions, which included the development of a digital submission process for approvals, aimed at streamlining processes and improving response times.
This system involved improving data sharing between providers and payers.
When rollout began in 2025, AHIP said in a statement the goal was to give providers an answer in real time. A goal was set for 2027, at which time at least 80% of approvals, assuming they were submitted digitally, were said to receive an immediate response.
This recent update did not provide details on where that number currently stands. It’s also not clear if a reduction in the number of prior authorizations has equated to fewer denials of care overall, as the survey was limited in scope.
However, insurers agreed to have all non-approved requests reviewed by medical professionals, who would then provide a clinical reason for why patient care was deemed unnecessary, as part of the reform effort.
Most major health plans are on board
The AHIP survey was conducted in partnership with the Blue Cross Blue Shield Association (BCBSA), which noted that its plans are participating in the program and committed to scaling back the use of prior authorizations.
“During the past 10 months, the Blues made significant, measurable strides toward delivering on our promise to make this process faster, simpler and more transparent,” Kim Keck, CEO of the Blue Cross Blue Shield Association, said. “Moving forward, we will focus on our commitment to address 80% of electronic prior authorization requests in real-time, at the speed of care.
“We share the Centers for Medicare & Medicaid Services’ urgency to modernize the infrastructure of healthcare and understand that all of us—policymakers, payers and care providers—have a role to play in activating change,” she added.
The next phase of the ongoing push to reduce prior authorizations is set to take effect in 2027, AHIP noted. That involves streamlining the electronic submission process even further, in an effort to improve response times.
Plans participating in the pilot include BCBSA members, as well as CVS, Centene, Cigna, Elevance Health and others. Most major insurers have agreed to reform the framework.
Changes are being implemented across insurance types, including Medicare Advantage, commercial coverage and Medicaid managed plans.
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