Major health plans pledge to simplify prior authorizations (TechTarget)

In a significant industry move, major U.S. insurers—including UnitedHealthcare, Cigna, CVS Health, and Humana—have voluntarily pledged to streamline the prior authorization (PA) process. Announced by AHIP, the reforms aim to reduce administrative burdens and improve timely access to care.

Six key commitments include:

1. Standardizing electronic PA using FHIR APIs by Jan 1, 2027.
   
2. Reducing medical PA volumes by Jan 1, 2026.
   
3. Guaranteeing a 90-day continuity of care when patients change plans mid-treatment.
   
4. Providing clearer denial explanations and appeal pathways.
   
5. Achieving 80% real-time PA decisions electronically by 2027.
   
6. Ensuring clinical review of denials not approved on medical grounds.