In a recent roundtable, the Department of Health and Human Services and executives from top insurance providers pledged to address longstanding concerns around prior authorizations, aiming to reduce administrative burden and improve patient access to timely care.
The commitments come amid growing evidence that current prior authorization practices delay treatment, contribute to clinician burnout and increase healthcare costs.
A July 7 blog post by Coronis Health breaks down new initiatives and explores what’s ahead for patients, providers and payers.
Four takeaways:
1. Prior authorization delays care
A recent AMA survey revealed the scale of disruption caused by prior authorization requirements. On average, doctors complete 39 prior authorizations per week and spend 13 hours on them — with 40% of practices employing staff dedicated solely to these tasks. Nearly a third of authorizations are denied outright, and three in four physicians say denials have increased over the last five years. This results in delayed care, abandoned treatments, adverse outcomes and widespread physician burnout, with 88% saying prior authorizations worsen it.
2. 6 steps to a new process
Top payers — including UnitedHealthcare, Humana, Aetna, Elevance, and Kaiser Permanente — signed a joint pledge to implement key changes by 2026–2027. These include:
- Standardizing electronic submissions
- Reducing the number of services requiring prior authorization
- Honoring existing approvals during plan switches
- Enhancing transparency and appeals communication
- Expanding real-time approvals
- Requiring clinician review for all denials
Secretary Robert F. Kennedy, Jr. and CMS Administrator Dr. Mehmet Oz praised the effort as a move toward restoring trust and reducing care delays.
3. CMS expands prior authorization
Just days after the HHS roundtable, CMS launched a new six-year pilot called WISeR (Wasteful and Inappropriate Service Reduction). This voluntary program applies to 17 Medicare fee-for-service procedures, such as epidural steroid injections, and requires either prior authorization or pre-payment review. It’s a technology-based prior authorization program delivered to patients with traditional Medicare.
4. Mixed signals
While the industry’s pledges suggest a course correction, the WISeR pilot indicates that prior authorization may still expand. Though the new CMS program affects only traditional Medicare patients in five states, the Coronis blog points out that the messaging from HHS and CMS appears at odds. Whether these reforms ultimately reduce red tape or simply redirect it will depend on execution, enforcement and continued collaboration across public and private sectors.
