From repealing existing prior authorization requirements to adding new ones, here are four states tackling the prior authorization system this year.
The California Legislature is considering a bill that would prohibit prior authorizations for any healthcare service if the plan or insurer approved or would have approved not less than 90 percent of the prior authorization requests a provider submitted in the most recent completed one-year contracted period. If approved, the bill would go into effect on Jan. 1, 2026. The bill would also require insurers to provide physicians with an electronic prior authorization process option.
UnitedHealthcare Texas will begin requiring prior authorization for four medications on Sept. 17 based on new state guidelines for Texas' Medicaid program. The new prior authorization rules will impact members of the UnitedHealthcare Community Plan of Texas STAR, STAR Kids and STAR+PLUS.
Georgia Medicare Advantage beneficiaries will no longer face prior authorization requirements for cataract surgery after Humana rolled back its disputed requirements.
Michigan launched new prior authorization rules on June 1 that aim to make the process faster, more effective and more transparent. Rules include requiring urgent requests to be acted on within 72 hours and requiring insurers to provide an online option for submitting prior authorization requests.