Health Insurers Commit to Reform Prior Authorization Process, Kennedy Announces
Washington, D.C., June 23, 2025 — In a significant development aimed at improving patients’ access to healthcare, Health and Human Services Secretary Robert F. Kennedy Jr. announced Monday that several of the nation’s largest health insurance providers have pledged to reform the prior authorization process—a long-standing practice criticized for causing delays and denials in medical care.
Prior Authorization Under Scrutiny
Prior authorization is a utilization management tool used by insurers requiring advance approval before patients can receive certain tests, procedures, or medications. Intended as a cost-containment measure, it routinely forces patients and healthcare providers to navigate bureaucratic hurdles, sometimes causing treatment delays of days or even weeks. Approximately one in six insured adults reports experiencing problems related to prior authorization, according to a survey by the Kaiser Family Foundation (KFF).
The practice gained heightened national attention following the tragic shooting of Brian Thompson, CEO of UnitedHealth’s insurance subsidiary, in New York City last year—a crisis that underscored the tension and frustration surrounding healthcare access issues.
Insurer Commitments to Change
At Monday’s announcement, Kennedy revealed that major insurance companies—including Blue Cross Blue Shield Association, Cigna, Elevance Health, GuideWell, Humana, Kaiser Permanente, and UnitedHealthcare—have agreed on concrete steps to streamline prior authorization procedures. These reforms will be applied across private insurance markets, Medicare Advantage, and Medicaid programs.
According to America’s Health Insurance Plans (AHIP), the health insurance industry’s trade association, these changes have the potential to affect approximately 257 million Americans covered by health insurance.
Key components of the new commitments include:
-
Honor Existing Authorizations: Starting next year, if patients switch insurance plans mid-treatment, their new insurer will honor prior authorizations for similar services for up to 90 days.
-
Clearer Denial Explanations and Appeals Guidance: Insurers will provide easier-to-understand reasons when prior authorization requests are denied, along with step-by-step guidance on how to appeal those decisions.
-
Medical Review of Denials: All prior authorization denials will be reviewed by qualified medical professionals—a practice many insurers already follow, AHIP noted.
-
Enhanced Online Submission and Real-Time Responses: By 2027, insurers aim to enable electronic prior authorization requests with at least 80% answered in real time, significantly reducing wait times.
-
Potential Reduction in Prior Authorization Requirements: Some insurers may scale back the number of medical services requiring prior authorization in select cities or states, although specific services have yet to be detailed.
CMS officials also expressed interest in encouraging insurers to eliminate prior authorization for common, routine procedures—such as colonoscopies, cataract surgeries, and childbirth—to ease barriers further.
Industry Perspectives and Expert Caution
While the commitment from insurers marks a hopeful stride forward, health policy experts urge cautious optimism. Dr. Adam Gaffney, a critical care physician and assistant professor at Harvard Medical School, emphasized that prior authorization is unlikely to disappear entirely. “These changes will offer some incremental improvements, but fundamental reform is needed to dismantle the widespread barriers to care imposed by insurance firms,” he said.
Kennedy and Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services (CMS), acknowledged during the media event that similar promises were made in 2018 and 2023, but implementation was inconsistent. Dr. Oz suggested heightened urgency this time around, noting, “There’s violence in the streets over these issues,” referencing the Thompson shooting as a catalyst for renewed accountability.
Kaye Pestaina, director of the program on patient and consumer protection at KFF, highlighted that some changes, such as honoring prior authorizations during insurance transitions, could have tangible benefits for patients. However, she also acknowledged that the overall impact depends on enforcement and insurer follow-through.
Looking Ahead
CMS is actively collaborating with insurers to ease prior authorization for diagnostic imaging, physical therapy, and outpatient surgeries. Though the steps announced represent incremental progress, patients and providers alike will be watching closely to see if insurers deliver on their promises and reduce the administrative burdens that can delay critical healthcare.
Berkeley Lovelace Jr., reporting for NBC News, contributed to this article.