On Monday, the Blue Cross Blue Shield Association, AHIP—a trade organization representing insurers—and 48 carriers announced a new plan to reduce the administrative burden of prior authorization over the next two years. The group has pledged to decrease the number of required prior authorization requests, improve standardization and response times, and enhance coordination with healthcare providers.
This announcement echoes similar commitments made in 2018, when payers agreed to reform prior authorization practices by signing a consensus statement with organizations such as the American Medical Association (AMA), the American Hospital Association, and other healthcare groups. At that time, insurers outlined several commitments intended to ease requirements for providers and patients.
Despite these promises, data from AMA surveys indicate that physicians still consider prior authorization a significant barrier to care. In 2022, the AMA acknowledged ongoing problems: “Insurance companies are not following through with agreed upon prior authorization reform,” citing persistent negative survey results from physicians. Current survey findings show that doctors continue to face substantial difficulties due to prior authorization processes.
U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz, MD, have expressed optimism about this latest effort. According to Modern Healthcare, Dr. Oz said, “There’s violence in the streets over these issues” and “Americans are upset about it.” He believes greater insurer participation, public dissatisfaction with prior authorization procedures, and increased focus on interoperability could make this initiative more effective than past attempts.
The Florida Medical Association (FMA) stated it will monitor these efforts closely: “The FMA will work to ensure that this ‘commitment’ is not used as a shield to prevent carriers from being subject to reasonable legislation and regulations, such as time limits for responding to prior authorization requests and prohibitions on retroactive denials.” The association also noted skepticism regarding voluntary industry self-regulation without legislative protections for patients.
