Overview

• Dozens of health plans, including UnitedHealthcare, Aetna and Blue Cross Blue Shield, agreed to overhaul prior authorization across commercial, Medicare Advantage and Medicaid managed care markets covering about 257 million people.
• Insurers will cut the number of services requiring prior authorization by January 1, 2026, and honor existing approvals for up to 90 days when patients change plans to preserve continuity of care.
• Carriers committed to standardize electronic request formats and expand real-time decisioning to cover at least 80% of authorization requests by 2027.
• The pledge includes clearer communications on denials, with all decisions reviewed by medical professionals and new guidance on how patients can appeal.
• HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz will track compliance and have warned they may impose regulations if insurers fail to meet their targets.