Health insurers pledged in June 2025 to overhaul their processes as part of a Trump administration initiative to reduce the volume of prior authorization requirements and modernize how requests are handled.
Many insurers targeted Jan. 1, 2026, for measurable reductions, but how far have they gotten? While carriers say they are making progress, provider groups such as the American Medical Association contend that little has changed for patients and clinicians on the ground.
This tension matters to employers and HR executives who sponsor group health plans because prior authorization rules influence employee access to care, administrative costs and satisfaction with their health benefits.
Why prior authorization became a flash point
Prior authorization — or prior approval — requires clinicians to secure insurer signoff before performing procedures, prescribing certain medications or ordering tests. Plans say it helps control unnecessary or low-value care.
Providers argue that approvals can take hours or days, even for routine services, leading to delayed diagnoses or treatment. News reports of patients waiting for life-saving care, sometimes with tragic outcomes, have intensified scrutiny.
The June 2025 pledge aimed to blunt these concerns and respond to growing state and federal pressure to simplify the process. Most major insurers pledged to:
- Cut the number of medical services needing prior authorization, particularly common procedures like colonoscopies and cataract surgeries, by Jan. 1, 2026.
- Honor existing prior authorizations for 90 days when a patient changes insurers mid-treatment.
- Offer clearer explanations for denials and ensure all denials receive a medical review.
What the largest insurers are doing
UnitedHealthcare — The company dropped prior authorization requirements for 231 procedures in December 2025, including nuclear medicine studies, certain obstetrical ultrasounds and electrocardiography procedures. It previously reduced approval requirements for services with consistently high adherence to evidence-based guidelines.
Cigna — Cigna has eliminated prior authorization for nearly 100 services, added real-time status tools and expanded patient support teams that help members navigate approvals.
Humana — The insurer says it eliminated about one-third of outpatient prior authorizations, including for colonoscopies and certain imaging studies. It has committed to issuing decisions within one business day for at least 95% of complete electronic requests starting Jan. 1, 2026, and is working to automate approvals for most routine requests.
Aetna — Aetna is in the process of automating one in four PA approvals for near-instant decisions and using AI tools to help members navigate the system. It has started bundling multiple prior authorization requests for cancer imaging into single submissions and has expanded bundling to musculoskeletal services, certain surgeries, medications and related care.
Blue Cross Blue Shield plans — The association says BCBS plans around the country are reducing requirements and preparing January 2026 workflow changes. More detailed reporting is expected in spring 2026 as part of an industrywide dashboard.
State policy activity accelerates
States have become increasingly aggressive in regulating prior authorization, shaping reforms employers may encounter in the coming years. Recent actions include:
- Arkansas, West Virginia and others have implemented programs that exempt high-performing physicians from prior authorization requirements.
- Vermont requires 24-hour urgent decisions, while Virginia mandates 72-hour expedited reviews.
- Indiana, Delaware and Oklahoma have instituted professional review standards, requiring denials to be reviewed by clinical peers or physicians with specialty expertise.
- Maryland and Washington have instituted electronic submission mandates.
- Wyoming and other states have implemented continuity-of-care protections that require new insurers to honor existing approvals from a prior insurer for a specified period.
- Maine, Colorado and Alaska have codified transparency requirements, such as public reporting of approval and appeal data, clearer notices and mandated appeal instructions.
These state reforms, coupled with new federal timelines for Medicare Advantage and Medicaid starting in 2026, signal that regulatory pressure is likely to intensify.
Takeaway
Health insurers have pledged meaningful reductions in prior authorization, and the industry is watching to see what kind of changes they implement in 2026. The result should hopefully improve the health care experience for your employees, particularly those who have ongoing health issues that are expensive to treat.
