U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz convened a roundtable discussion with major health insurers in Washington, D.C. to address the complexities and inefficiencies surrounding prior authorization processes affecting nearly 80% of Americans. This collaborative effort resulted in a pledge from these insurers to implement six key reforms aimed at reducing bureaucracy and improving access to care.
Participating insurance companies, including industry leaders like Aetna, Blue Cross Blue Shield, Humana, and UnitedHealthcare, have committed to actions designed to simplify the prior authorization procedures for Medicare Advantage, Medicaid Managed Care, the Health Insurance Marketplace, and commercial plans. Secretary Kennedy emphasized the need for these changes, stating, “Americans shouldn’t have to negotiate with their insurer to get the care they need,” and mentioned the importance of avoiding conflicts between patients, doctors, and insurance companies.
Key reforms announced include the standardization of electronic prior authorization submissions, a reduction in the number of services requiring prior authorization, seamless continuity of care during insurance transitions, and improving communication regarding authorization decisions. Notably, insurers have also pledged to provide real-time authorization approvals by 2027 and ensure that medical professionals review all clinical denials.
Congress also expressed support for these measures. Senator Roger Marshall highlighted the significance of this initiative as a long-overdue solution to a persistent issue, while Congressman Greg Murphy, drawing from his experience as a physician, praised the collaborative effort to alleviate the burdens placed on healthcare providers and patients by insurance-related delays.
These private sector reforms align with ongoing efforts by CMS to enhance prior authorization processes and promote a transparent and efficient healthcare system. While the insurance industry steps forward with these initiatives, CMS will continue to monitor progress and, if necessary, pursue additional regulatory actions to ensure effective implementation.
There is a hopeful outlook as these commitments may restore trust between patients and insurers, providing a pathway toward more timely access to critical healthcare services, ultimately emphasizing patient-centered care in the system.