Prior authorization reform is moving on multiple fronts in 2026 — through Congress, state capitals, federal courtrooms and the exam rooms where physicians spend an average of 13 hours per week on PA paperwork alone. Here are 10 recent updates on policy, data and physician sentiment.
1. 94% of physicians say prior auth harms patient outcomes. The American Medical Association’s ‘2025 AMA Prior Authorization Physician Survey,‘ released May 13, found that 94% of physicians said prior authorization has a somewhat or significantly negative impact on patient clinical outcomes. Only 1% reported a positive impact. The survey collected responses from 1,000 practicing physicians across specialties and practice settings in December 2025.
2. PA is driving serious adverse events. More than 1 in 4 physicians — 26% — told the AMA that prior authorization has led to a serious adverse event for a patient in their care, with 23% reporting it led to a hospitalization. Another 18% said PA has resulted in a life-threatening event or required intervention to prevent permanent impairment, and 8% said it has led to a patient’s disability, permanent bodily damage or death, according to the AMA survey.
3. The administrative burden keeps growing. Physician practices complete an average of 39 PAs per physician per week, with physicians and their staff spending 13 hours weekly completing them. Forty percent of practices now have staff who work exclusively on prior authorization — a signal of how much operational infrastructure the process consumes.
4. Payer pledges aren’t registering with physicians. More than 60 major health insurers pledged to streamline PA processes in 2025, and UnitedHealthcare has separately committed to reducing commercial prior authorization requirements by 30%. But physicians aren’t seeing it. Only 16% of physicians working with UnitedHealthcare and 16% working with Cigna said those companies’ announced reductions actually cut the number of PAs they complete, per the AMA survey. Eighty-four percent said the number of PAs for prescription medications has increased over the past five years; 82% said the same for medical services.
5. WISeR is drawing bipartisan fire in Congress. The House Appropriations Committee voted June 9 to advance an amendment that would block funding for CMS’s Wasteful and Inappropriate Service Reduction model, the AI-enabled prior authorization pilot operating in six states for traditional Medicare. The amendment, adopted by voice vote, would prohibit any appropriated funds from going to WISeR or similar models and called on CMS to provide Congress with an update on patient impact and provider burden. The full spending bill has not yet passed; a comparable amendment for the 2026 spending bill cleared committee last year but did not make the final legislation.
6. Democrats are pressing CMS for WISeR data. On June 22, 31 House Democrats sent a letter to CMS Administrator Mehmet Oz, MD, requesting data on the WISeR pilot by July 15. The lawmakers cited reports of care denials, longer wait times and increased administrative burden since the model launched in January in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington. Their letter referenced HHS Office of Inspector General data showing that 75% of denied prior authorization requests in Medicare Advantage were overturned on appeal. The Government Accountability Office ruled in May that WISeR is subject to the Congressional Review Act, giving Congress 60 days to disapprove of the model.
7. Neurosurgeons back reform legislation in Medicare Advantage. The American Association of Neurological Surgeons applauded the House Energy and Commerce Committee’s Subcommittee on Health for advancing the Improving Seniors’ Timely Access to Care Act on June 25. The bipartisan bill would establish electronic prior authorization standards, increase transparency and streamline determinations for medically necessary care in Medicare Advantage, which covers more than 35 million beneficiaries. The legislation now advances to the full Energy and Commerce Committee. The AANS noted that prior authorization delays can postpone treatment for conditions including brain tumors, stroke, seizures and spinal cord compression, raising the risk of disability or neurologic injury.
8. Massachusetts enacted the country’s most expansive state-level restrictions. Prior authorization regulations finalized by Gov. Maura Healey took effect June 5, prohibiting PA requirements for emergency and urgent care, primary care, radiology imaging following a cancer diagnosis, preventive services, maternity care, physical and occupational therapy, outpatient substance use disorder treatment and certain medications. Insurers must now respond to urgent prior authorization requests within 24 hours and honor existing authorizations for at least 90 days when patients switch plans. The regulations cover roughly half of commercially insured enrollees in the state — self-insured plans remain exempt under federal law.
9. WISeR is producing wait times two to four times longer, a senator’s report found. A report from Senator Maria Cantwell, a Democrat from Washington, found that patients in WISeR pilot states are experiencing authorization wait times roughly two to four times longer than before the model launched — up from one to two days for quick requests and three to five days for standard ones to 10 to 15 days, according to Healio. Providers in the pilot states are spending more time appealing claims as a result, the senator wrote.
10. Gold-carding remains rare — in practice and under WISeR. Only 10% of physicians contract with health plans that offer gold card or PA-exempt programs, according to the AMA survey. CMS is planning to launch a gold-carding exemption program under WISeR, with notifications to qualifying providers expected to begin in June 2026, according to agency guidance.
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