News|Articles|August 26, 2026

FAQ: Prior Authorization Reform—Will Changes Go Far Enough by 2027?

AHIP's Jeanette Thornton details health care's prior authorization commitments as a 2027 real-time approval target approaches.

Prior authorization is entering a new phase as health plans pursue voluntary reforms aimed at simplifying submissions, expanding electronic prior authorization, and delivering faster decisions by 2027. But with physicians continuing to report high administrative burdens and skepticism about whether insurer commitments will translate into meaningful change, the coming year will test whether these efforts can deliver measurable improvements for providers and patients.

This FAQ covers the current prior authorization landscape, what's coming, and what health care stakeholders can expect.

Q: How many health plans have committed to reform, and what's the scale of the effort?

Health plans representing 270 million Americans across the commercial, Medicare, and Medicaid markets have signed onto voluntary commitments to modernize prior authorization, Jeanette Thornton, executive vice president of policy and strategy at AHIP, told The American Journal of Managed Care^®(AJMC^®). Participation spans national plans, regional and state-based plans, and integrated delivery system plans, reaching across commercial, Medicare, and Medicaid lines of business.

AHIP reported at its 2026 annual conference that prior authorization volume has fallen 11% over the past year—roughly 6.5 million fewer authorizations for provider organizations—as an early marker of progress under the commitments.¹

Q: What's actually changing for providers?

The commitments center on 2 mechanisms: broader adoption of electronic prior authorization (ePA) and standardized submission requirements across plans.

"Greater adoption of ePA and standardizing the submission process for prior authorization requests will speed up and simplify the process significantly compared to the more manual methods," said Thornton. "The goal of these commitments is to create a more consistent and streamlined process across all markets."

Currently, providers face a wide range of different submission processes and requirements that vary by plan, according to Thornton. Standardized documentation fields are intended to change that.

"A significant amount of work is underway between participating plans, vendors, and provider partners to implement newly adopted standardization fields for simpler, streamlined submission processes," she said. "By clearly defining and standardizing the information needed to support most prior authorization requests, this initiative aims to substantially reduce back-and-forth with providers, lower administrative burden, and help patients and providers get answers faster.”

Longer term, the goal is for prior authorization to become part of a clinician's existing electronic health record workflow rather than a separate process navigated plan by plan. Services for standardization were selected based on high prior authorization volume and clinical complexity, with the same criteria guiding expansion to additional services beginning in 2027.

Q: What's the regulatory backdrop driving the 2027 target?

The voluntary industry commitments run alongside binding federal requirements. CMS's Interoperability and Prior Authorization Final Rule (CMS-0057-F) requires Medicare Advantage organizations, state Medicaid and Children's Health Insurance Program (CHIP) fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and qualified health plan issuers on the federally facilitated exchanges to implement a Prior Authorization API, with compliance dates for the API requirements beginning in 2027. Other provisions, including requirements for specific denial reasons, decision timeframes, and reporting, take effect in 2026.²

CMS also proposed in April 2026 to extend many of these interoperability and electronic prior authorization requirements to drugs. The CMS-0062-P proposed rule would establish additional requirements for electronic drug prior authorization, including proposed compliance dates beginning October 1, 2027. Because the rule is proposed, these provisions are not yet binding.³

According to Thornton, the industry's own standardization commitment is timed to roll out in parallel with these CMS interoperability requirements, with full implementation beginning in January 2027.

Q: Will the reforms hit their targets, and do physicians believe they will?

AHIP's stated goal is ambitious: "The industry is committing to providing 80% of prior authorization approvals in seconds, reducing the administrative burden for providers and leading to faster care for patients," Thornton said. The commitment applies to at least 80% of prior authorization approvals when requests are submitted electronically with all necessary clinical documentation; it does not mean that 80% of all prior authorization requests will be approved instantly.

Physician sentiment suggests real skepticism remains. In the 2025 American Medical Association (AMA) Prior Authorization Physician Survey, released in 2026, the AMA surveyed 1000 practicing physicians and found that only 1 in 3 (33%) believe the latest insurer pledge will make a meaningful difference.⁴ The same survey found that 88% of physicians say prior authorization increases overall health care utilization rather than reducing waste, 94% say it contributes to burnout, and physicians complete an average of 40 prior authorization requests per week, consuming roughly 13 hours of physician and staff time. Nearly a third of physicians (32%) reported that requests are often or always denied, and 74% said denial rates have increased over the past 5 years.

That skepticism is rooted partly in history. A 2018 consensus statement on improving prior authorization, backed by AHIP alongside the AMA, American Hospital Association, American Pharmacists Association, and Medical Group Management Association, outlined 5 areas for reform.⁵ Subsequent assessments from provider organizations have characterized progress from voluntary reforms as limited, while physicians continue to report substantial administrative burden associated with prior authorization.

Q: What does this mean for managed care?

The gap between AHIP's reported progress and physician sentiment underscores why 2027 functions as a credibility test as much as an operational one. Payers have a public industry target alongside binding CMS interoperability requirements and 2027 compliance dates.² For managed care organizations, the practical work between now and 2027 involves scaling ePA adoption, implementing standardized documentation fields, and building the Fast Healthcare Interoperability Resources–based infrastructure CMS requires, all while an increasingly skeptical physician base tracks denial rates, response times, and administrative burden as the real measure of whether this round of reform delivers where earlier voluntary efforts fell short.^2,4

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