Health insurers covering approximately 75% of the U.S. population have pledged to reform their prior-authorization processes, a move aimed at reducing bureaucratic barriers in healthcare. The initiative, announced this week by Dr. Mehmet Oz, director of the Centers for Medicare and Medicaid Services, and Health and Human Services Secretary Robert F. Kennedy Jr., seeks to streamline approvals to improve patient care and reduce administrative strain on healthcare providers.
This voluntary pledge, signed by major insurers including UnitedHealthcare, Cigna, Humana, and Blue Cross & Blue Shield, outlines key commitments. These include implementing a standardized electronic prior-authorization process by January 1, 2027, and reducing the use of medical prior-authorization for individual plans by January 1, 2026. The reform also ensures that patients will retain prior-authorization approvals for 90 days when switching insurers during treatment, preventing disruptions in care.
Dr. Oz emphasized the importance of these changes, stating that the streamlined process would help reduce the 12-hour weekly burden on doctors, who currently spend significant time managing prior-authorization requirements. He also highlighted the need for transparency, with plans to provide clear explanations of prior-authorization decisions and enable real-time approvals for 80% of electronic requests by 2027.
The pledge represents a significant step in addressing long-standing criticisms of the insurance system, which have been highlighted in recent reports. While the reforms are expected to improve care, they could also impact insurer profits as patients may access more services. Oz likened the initiative to a biblical call to ‘be meek,’ noting that the industry’s collaboration has prioritized patient care over profit for now.