Will Cigna’s Pledge to Improve Prior Authorization Satisfy Insurers’ Critics?

The Cigna Group recently announced it is working to streamline its prior authorization (PA) processes. Experts tell AIS Health that while PA improvements are sorely needed, the move appears to mostly be aimed at quelling public outcry about health insurers that followed the December shooting death of UnitedHealthcare CEO Brian Thompson. “You could not even pretend that you’re responding to the firestorm that the Brian Thompson murder opened up if you weren’t addressing prior authorization,” Michael Abrams, managing partner at consulting firm Numerof & Associates, tells AIS Health, a division of MMIT. “That was one of the key sore points for people across the country.” On Feb. 3, Cigna announced a series of new initiatives, including tying executive compensation to customer satisfaction scores and streamlining PA through Cigna’s physician portal and the electronic medical record. “This will give physicians an easier way to submit all the necessary information the first time, improving turnaround time and accuracy,” according to the announcement. The insurer will also employ concierges to assist patients and physicians with any information gaps in the PA requests to help “prevent stress and confusion” for patients. Patients will be able to view the status of their PA request through a digital tracker. Cigna has earmarked $150 million for the initiatives and is creating a new department to oversee them. “We are committing to significantly improving the prior authorization process for patients and for those providing care,” said Amy Flaster, chief medical officer, Cigna Healthcare. “We want to reduce the burden on our physician partners by making it easier to submit a complete authorization request quickly and correctly the first time, expediting the path to getting needed services approved and giving providers their time back so they can invest it in what matters most: patient care.” American Medical Association President Bruce Scott, M.D., welcomed Cigna’s PA announcement. But he also said in a statement that he wants the insurer to commit to broader reforms that include “taking immediate actions significantly reducing the volume of authorization requirements, using transparent and evidenced-based clinical criteria, ensuring that qualified physicians are the only ones making denials, and requiring that decisions are made within hours, not days or weeks.” During UnitedHealth Group’s fourth-quarter 2024 earnings call in January, CEO Andrew Witty said the company is “eager to work with policy leaders to use standardization and technology to speed up turnaround times for approval of procedures and services for Medicare Advantage patients and to materially reduce the overall number of prior authorizations used for certain MA services.” While Witty did not give details as to how the insurer might accomplish this, it looks as though UnitedHealth is responding to the “shocking” public response to the shooting death of UnitedHealthcare CEO Brian Thompson in December, says Carrie Graham, director of the Medicare Policy Initiative at Georgetown University’s Center on Health Insurance Reforms (CHIR). “It was a tipping point in the understanding that the public doesn’t think the way prior authorizations and denials are happening is acceptable,” Graham says. MA Prior Auth Needs Specific Actions Indeed, PA is no longer an issue that only appears on the radar of policy experts and those who work in the health care industry, Graham notes. “It’s on TikTok. It’s out there in the world that these denials of appropriate care [are occurring] in Medicare where people have been paying into this their whole working career. MA plans must provide the same benefits as traditional Medicare,” she tells AIS Health. One issue is that many plan sponsors contract PA to third-party companies that use complicated algorithms, says Neil Patil, a senior fellow and policy director at CHIR’s Medicare Policy Initiative. Insurers might not be “looking under the hood” at their PA policies or following how closely the vendors are adhering to CMS regulations. “Sometimes, the MA organizations might not understand the algorithms happening there,” Patil says. “But the bottom line is that regardless of what technology these plans are using, they still need to follow traditional Medicare laws.” While CMS has the authority to oversee the plans, it doesn’t have the authority to oversee contracted vendors, Patil adds. “MA organizations are in charge of making sure the [vendors] follow the rules,” he says. “How well they’re enforcing the rules, or how much they’re digging into that, is up to them.” Graham and Patil agree that transparency is a key to improving PA. MA plans must share data with CMS on the overall numbers of PA requests and denials. But they do not have to report denials by service or the demographics of patients. CMS this year began requiring plans to report service-level denial information. And beginning in 2026, MA plans must provide specific reasons for PA denials. Providing customers with information to distinguish between plans is “a precondition of the free market.” “The ideal thing would be for people to go on the [Medicare] Plan Finder and say, ‘OK, I’m looking for a plan, I know I’m going to need chemotherapy in the next year — can I look at the rates of denials for imaging and certain kinds of chemotherapy?’” That would be a way for patients to use the free market “to really make an informed choice, and you could see which of the plans are denying care at different rates,” Graham explains. “It would give people an important and meaningful data point. Right now, there’s not a lot of that.” Speeding response times is also crucial for PA reform, Patil says. For services that are frequently approved, “there’s no reason that those should still take 14 days or even seven days,” he adds. To further smooth the PA process, CMS’s proposed rule for the 2026 calendar year included provisions redefining “internal coverage criteria,” modifying the appeals process, and adding more specific rules about public posting of internal coverage criteria content on MA organizations’ websites. The CMS Interoperability and Prior Authorization Final Rule, meanwhile, will require MA plans to build application programming interfaces to streamline PA beginning in 2026. “This will be great because we’ve been hearing for so long that plans and providers are still using fax machines and all this old, outdated technology,” Patil says. Will Federal PA Legislation Pass? Abrams finds it “disappointing” that a federal PA bill, the Improving Seniors’ Timely Access to Care Act, has not come up for a vote despite bouncing around both chambers of Congress since 2021. The bill was reintroduced in the Senate last summer and includes elements such as establishing an electronic PA process, requiring greater transparency into the PA process and the data used for determinations, and further streamlining and expediting decisions for commonly approved items and procedures. “It's disappointing to read about all the time that they put into [the bill] which I think proposed some good things, some of which UHG and Cigna are now doing on their own,” Abrams says. “But the point is this is something that needs to be regulated by the authorities who presumably exercise oversight over the industry. And even though there seems to have been bipartisan support for the legislation, somehow it hasn’t come to the floor.”