On Monday, the Blue Cross Blue Shield Association, AHIP, and 48 insurance carriers announced a new plan to address ongoing concerns with prior authorization requirements. Over the next two years, these insurers have committed to reducing the total number of prior authorization requests, improving standardization and response times, and enhancing coordination with healthcare providers.
This is not the first time insurers have made such promises. In 2018, payers signed a consensus statement with organizations including the American Medical Association (AMA), the American Hospital Association, and others representing pharmacists and medical group managers. The agreement included commitments aimed at making prior authorization less burdensome for providers.
Despite these earlier efforts, survey data from the AMA has shown that physicians continue to face significant challenges related to prior authorization. According to AMA surveys through 2022, doctors report that these requirements remain a major barrier to patient care. The AMA stated in 2022: “Insurance companies are not following through with agreed upon prior authorization reform,” pointing to continued negative feedback from physicians about their experiences.
Federal officials have commented on the renewed effort by insurers. U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz expressed optimism about this latest initiative. Dr. Oz told Modern Healthcare: “There’s violence in the streets over these issues” and “Americans are upset about it.” He added that he believes this attempt will be different due to more insurer participation, public dissatisfaction with current practices, and an increased focus on interoperability.
The Florida Medical Association (FMA) has indicated it will monitor whether this commitment leads to meaningful change or if it is used as a reason for insurers to avoid new regulations such as mandated response times or bans on retroactive denials of coverage. The FMA noted skepticism remains high regarding voluntary self-regulation by insurers without legislative oversight.