Is Insurers’ Prior Authorization Pledge a PR Move or True Reform?

Jun 27
Jun 27, 2025

Amid mounting consumer, provider and lawmaker frustrations over insurers’ reliance on prior authorizations to control medical costs, a group of payers including major publicly traded companies recently unveiled a pledge to revamp their own PA practices before the federal government takes action. But industry experts say much of what they’re promising is already being mandated in federally sponsored health care programs, and it remains to be seen whether they’ll be ready to adopt these changes on the commercial side, let alone in Medicare or Medicaid.

On June 23, AHIP unveiled a six-pronged plan to improve PA processes across business lines including commercial, Medicare Advantage and managed Medicaid. By Jan. 1, 2026, nearly 50 undersigned organizations intend to: (1) reduce the number of medical procedures subject to PA “as appropriate for the local market each plan serves,” (2) honor existing PAs for in-network services when enrollees change plans as part of a 90-day transition period, and (3) “provide clear, easy-to-understand explanations” of PA decisions, including how to appeal.
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Lauren Flynn Kelly

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.