Insurers Cut 11% of Prior Authorizations, Expand Continuity-of-Care Protections

Major US health insurers have eliminated roughly 11% of prior authorization requirements and introduced new continuity-of-care protections, marking early progress on a voluntary reform pledge aimed at reducing administrative burdens and improving patient access to care.^1,2

“During the past 10 months, the Blues made significant, measurable strides toward delivering on our promise to make this process faster, simpler, and more transparent,” Kim Keck, CEO of the Blue Cross Blue Shield Association, said in the statement.¹ “Moving forward, we will focus on our commitment to address 80% of electronic prior authorization requests in real time, at the speed of care. We share CMS‘ urgency to modernize the infrastructure of health care and understand that all of us—policy makers, payers, and care providers—have a role to play in activating change.”

The changes stem from a June 2025 commitment by nearly 60 insurers—including the nation’s largest payers—to streamline prior authorization, a process that requires providers to obtain insurer approval before delivering certain treatments or medications.² The initiative, developed in collaboration with federal officials at CMS and HHS, set targets for reducing unnecessary approvals, improving transparency, and accelerating decision-making.

According to new data shared by America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association, insurers have now achieved an 11% reduction in prior authorization requirements across participating markets, equivalent to approximately 6.5 million fewer authorization requests for patients. The reductions have been particularly notable in Medicare Advantage, where prior authorization use has declined by more than 15%.

Health plans say the cuts primarily target services with well-established clinical guidelines and consistent utilization patterns, allowing insurers to remove requirements for routine or low-risk care. Industry leaders argue this approach helps maintain safeguards against unnecessary or high-cost care while reducing friction for both providers and patients.

In parallel, insurers have implemented new policies to support continuity of care—one of the most closely watched elements of the reform effort.¹ Patients who switch health plans during treatment will now be able to maintain existing prior authorizations for a transition period, typically 90 days, ensuring ongoing care is not disrupted. This change addresses long-standing concerns that patients could face delays or denials when changing coverage midtreatment.

Insurers have also committed to improving communication around prior authorization decisions, including clearer explanations of denials and guidance on appeals. Additionally, plans are expanding the use of electronic prior authorization systems, with a longer-term goal of processing most requests in real time.^1,2

“These changes are helping to reduce administrative burdens and accelerate access to evidence-based care,” the groups stated.¹

Despite the reported gains, prior authorization remains a significant source of frustration across the health care system.² Providers have long argued that the process contributes to delays in care, increased administrative workload, and even negative patient outcomes. At the same time, insurers maintain that prior authorization plays a necessary role in controlling costs and ensuring appropriate use of services.

The reforms are voluntary, and some stakeholders remain skeptical about their long-term impact. Previous industry pledges to improve prior authorization have faced criticism for limited follow-through, and policy makers continue to weigh whether additional regulatory action may be needed.

Beyond the reduction in authorization volume, insurers estimate the reforms will save providers millions of administrative hours and contribute to a more streamlined care experience.

Further changes are expected in the coming years. Participating insurers have pledged to implement standardized electronic prior authorization systems by 2027 and to process a majority of requests in real time, signaling a broader shift toward automation and interoperability in health care administration.

“Health plans have taken important initial steps to support patients and are working toward the shared goal of delivering answers at the point of care whenever possible—a goal that will require both plans and providers to eliminate manual processes and adopt real-time electronic data sharing,” Mike Tuffin, AHIP CEO and president, said in the statement.¹

References

1. Health plans reduce prior authorization, support continuity of care and enhanced consumer communications. News release. Blue Cross Blue Shield Association. April 7, 2026. Accessed April 8, 2026. https://www.bcbs.com/about-us/association-news/health-plans-reduce-prior-authorization-continuity-of-care
2. Minemyer P. Insurers have eliminated 11% of prior authorizations under reform pledge. Fierce Healthcare. April 7, 2026. Accessed April 8, 2026. https://www.fiercehealthcare.com/payers/insurers-have-eliminated-11-prior-authorizations-under-reform-pledge