07/30/2025

RFK, Dr. Oz Secure Insurance Industry Pledge to Fix Broken Prior Authorization System

New Commitments Aim to Accelerate Decision Timelines, Increase Transparency, Expand Access to Affordable Quality Care

U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz today met with industry leaders to discuss their pledge to streamline and improve the prior authorization processes for Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace® and commercial plans covering nearly eight out of 10 Americans.

In a roundtable discussion hosted by HHS, health insurers pledged six key reforms aimed at cutting red tape, accelerating care decisions, and enhancing transparency for patients and providers. CMS is committed to monitor outcomes and promote accountability.

Among the companies and organizations represented at the roundtable were Aetna, America's Health Insurance Plans (AHIP, the national trade association representing the health insurance industry), the Blue Cross Blue Shield Association, Cigna Highmark Health, Humana, Kaiser Permanente, and UnitedHealthcare. A full list of participating health plans is available here. at: www.ahip.org/supportingpatients.

“Americans shouldn’t have to negotiate with their insurer to get the care they need,” said Secretary Kennedy. “Pitting patients and their doctors against massive companies was not good for anyone. We are actively working with industry to make it easier to get prior authorization for common services such as diagnostic imaging, physical therapy, and outpatient surgery.”

“These commitments represent a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care,” said Administrator Oz. “We applaud these voluntary actions by the private sector, which is how these types of issues should be solved. CMS will be evaluating progress and driving accountability toward our shared goals, as we continue to champion solutions that put patients first.”

The participating health insurers’ pledge includes:

Standardizing Electronic Prior Authorization. Participating plans will work to implement common, transparent submissions for electronic prior authorization. This commitment includes the development of standardized data and submission requirements that will support seamless, streamlined processes and faster turn-around times. The goal is for the new framework to be operational and available to plans and providers by January 1, 2027.

• Reducing the Scope of Claims Subject to Prior Authorization. Individual plans will commit to specific reductions to medical prior authorization as appropriate for the local market each plan serves, with demonstrated reductions by January 1, 2026.
• Ensuring Continuity of Care When Patients Change Plans. Beginning January 1, 2026, when a patient changes insurance companies during a course of treatment, the new plan will honor existing prior authorizations for benefit-equivalent in-network services as part of a 90-day transition period. This action is designed to help patients avoid delays and maintain continuity of care during insurance transitions.
•  Enhancing Communication and Transparency on Determinations. Health plans will provide clear, easy-to-understand explanations of prior authorization determinations, including support for appeals and guidance on next steps. These changes will be operational for fully insured and commercial coverage by January 1, 2026, with a focus on supporting regulatory changes for expansion to additional coverage types.
• Expanding Real-Time Responses. In 2027, at least 80 percent of electronic prior authorization approvals (with all needed clinical documentation) will be answered in real-time.
• Ensuring Medical Review of Non-Approved Requests. Participating health plans affirm that all non-approved requests based on clinical reasons will continue to be reviewed by medical professionals – a standard already in place. This commitment is in effect now.

According to the plans taking the pledge, these commitments will benefit patients through faster, more direct access to appropriate treatments and medical services with fewer challenges navigating the health system. For providers, these commitments will streamline prior authorization workflows, allowing for a more efficient and transparent process overall, while ensuring evidence-based care for patients.

These commitments are being implemented across insurance markets, including for those with commercial coverage, Medicare Advantage, and Medicaid managed care consistent with state and federal regulations, and are estimated to benefit more than 250 million Americans. Stay tuned for more information.

Sources:

U.S. Department of Health and Human Services Press Release, “HHS Secretary Kennedy, CMS Administrator Oz Secure Industry Pledge to Fix Broken Prior Authorization System,” June 23, 2025

AHIP Press Release, “Health Plans Take Action to Simplify Prior Authorization,” June 23, 2025

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