On Monday, the Blue Cross Blue Shield Association, AHIP, and 48 insurance carriers announced a new plan aimed at reducing the administrative burden of prior authorization over the next two years. The initiative includes commitments to decrease the number of prior authorization requests, improve standardization and response times, and enhance coordination with healthcare providers.
This announcement follows a similar effort in 2018 when insurers joined other major healthcare organizations in pledging to reform prior authorization practices. Despite these previous promises, surveys from the American Medical Association (AMA) have indicated that physicians continue to face significant challenges related to prior authorization requirements. In 2022, the AMA stated, “Insurance companies are not following through with agreed upon prior authorization reform,” pointing to ongoing negative survey results from doctors.
Current data show that many physicians still experience serious difficulties due to prior authorization processes, and there has been little sign of improvement since earlier reform efforts.
U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz, MD, have expressed optimism about this renewed commitment from insurers. In a recent Modern Healthcare article, Dr. Oz said, “There’s violence in the streets over these issues” and “Americans are upset about it.” He believes that greater insurer participation, increased public dissatisfaction with current practices, and a focus on interoperability could make this attempt more successful than past efforts.
The Florida Medical Association (FMA) has stated it will monitor these developments closely to ensure that insurer commitments do not prevent reasonable legislative or regulatory measures—such as time limits for responses or bans on retroactive denials—from being enacted. The FMA noted that skepticism remains about whether voluntary actions by insurers will be sufficient without additional protections for patients.
