Healthcare’s long-promised overhaul of prior authorisation remains a work in progress, with frontline physicians reporting limited improvements despite industry pledges and new federal requirements.
A new American Medical Association survey found that only one in three physicians believe a broad insurer pledge to reform authorisation would produce meaningful changes for patients and practices.
While policy discussions have centred on reducing administrative burden, clinicians say that improvements in approval timelines and treatment access remain limited in day-to-day practice.
The gap between industry commitments and clinical reality has become one of the defining tensions in healthcare administration heading through 2026, with pressure mounting on payers to demonstrate concrete results.
Under the 2024 Interoperability and Prior Authorization Rule, payers were required to begin publicly posting prior authorisation metrics for the first time, with the first reports covering 2025 data due March 31.
Those transparency requirements represent a significant shift in accountability, forcing insurers to expose their authorisation practices to public scrutiny in a way that was not previously required.
The industry’s next major milestone arrives in 2027, when payers have committed to implementing standardised electronic prior authorisation submissions and processing at least 80% of electronic approvals in real time.
Aetna has reported early progress, saying it has already standardised 88% of its prior authorisation volume, while UnitedHealthcare and Cigna have each committed to standardising at least 70% of theirs.
However, an inaugural Aetna provider survey released in April found that only 36% of providers believe payers reliably deliver on their promises more broadly, raising questions about trust across the sector.
The Centers for Medicare and Medicaid Services has recently proposed sweeping new rules expanding prior authorisation reform to prescription drugs, aiming to speed up and simplify the approval process.
That proposed rule was open to public comments until mid-June, and if approved could be finalised by the end of the year, potentially reshaping how drug approvals are handled across federal programmes.
It builds on a 2024 rule that set new timelines and transparency requirements for prior authorisation covering medical services, extending the reform effort into the pharmaceutical space for the first time.
The proposed expansion signals that regulators are not satisfied with the pace of voluntary change and are prepared to use rulemaking to force faster adoption across the healthcare system.
For physicians, the central frustration remains the daily reality of navigating approvals that delay treatment, consume staff time, and in some cases lead patients to abandon recommended therapies altogether.
Whether the combination of federal mandates, payer commitments, and growing transparency requirements will translate into meaningful improvement at the point of care remains the central question for the months ahead.