The prior authorization process is in the spotlight as the majority of Americans say delays and denials of services and treatments by health insurance companies are a major problem. This sentiment is shared across demographic groups, political affiliations and income levels, according to a KFF survey.
About half of insured adults have had to get a prior authorization in the past 2 years, and 47% said the process was somewhat or very difficult to navigate. Among all of those who reported needing prior authorization in the past two years, about half say their health insurance company has delayed their ability to get or denied coverage for a service, treatment or medication that their doctor requested.
In June, a voluntary initiative to reduce the burden of prior authorizations for patients was introduced by a group of health insurance companies, Secretary of Health and Human Services Robert F. Kennedy Jr. and Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services. The pledge was coordinated through the America’s Health Insurance Plans trade association. Promises of the initiative include requiring prior authorization less often, speeding up the review process and using clear language when communicating with patients. Plans adopting the pledge include more than 30 Blue Cross Blue Shield entities, as well as large national insurers including UnitedHealthcare, Humana, the Cigna Group, and CVS Health Aetna. Centene, the largest Medicaid insurer, is also participating.
However, only a small percentage of people have heard of the initiative, and few people believe health insurance companies will follow through on the pledge in a way that makes a difference for patients.
Some services are more often subject to prior authorization, including surgery, hospitalization, imaging services, specialty drugs, specialty medical equipment, care from a specialist, specialized lab testing, and mental health services. Insurers say they require prior authorization to prevent unnecessary procedures and medications and to keep costs down. Providers and patients, on the other hand, say prior authorizations can slow treatments and harm patients.
The American Medical Association praised the announcement but noted similar pledges were announced in 2018 and 2023.
“The AMA intends to carefully monitor the implementation of these pledged reforms, gauge their impact, and do everything in our power to see that good intentions become concrete reality,” said AMA President Bobby Mukkamala.