WASHINGTON, D.C. — U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr., and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz convened with leaders from the nation’s largest health insurers last week to announce major commitments aimed at improving prior authorization processes. The commitments focus on reducing administrative barriers, enhancing efficiency, and ensuring patients receive timely access to care.
The roundtable discussion hosted by HHS featured representatives from 12 leading insurers, including Aetna, Inc., Humana, Inc., and UnitedHealthcare, who pledged six key reforms to simplify and standardize the prior authorization system. Together, these commitments are expected to impact nearly 80% of Americans covered under Medicare Advantage, Medicaid Managed Care, commercial plans, and the Health Insurance Marketplace®.
“Thank you to the insurance companies for making these commitments today. Americans shouldn’t have to negotiate with their insurer to get the care they need,” stated Secretary Kennedy. “Pitting patients and their doctors against massive companies was not good for anyone. We are actively working with industry to make it easier to get prior authorization for common services such as diagnostic imaging, physical therapy, and outpatient surgery.”
Administrator Oz emphasized the collaborative nature of the initiative, remarking, “These commitments represent a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care. CMS will be evaluating progress and driving accountability toward our shared goals, as we continue to champion solutions that put patients first.”
The pledges made by participating insurers include:
- Standardizing electronic prior authorization processes using Fast Healthcare Interoperability Resources (FHIR®)-based technology.
- Reducing the number of medical services requiring prior authorization by January 1, 2026.
- Preserving authorizations during insurance transitions to maintain continuity of care.
- Improving communication and transparency around authorization decisions and appeals.
- Expanding real-time approvals for most requests by 2027 to minimize delays.
- Ensuring all clinical denials are reviewed by medical professionals.
The reforms also garnered accolades from lawmakers. Senator Roger Marshall, M.D. (R-KS) praised the initiative, stating, “This is an important topic that has continued to be an issue for far too long. I applaud the leadership of Secretary Kennedy and President Trump for bringing us all to the table to find solutions for our patients and providers.”
Similarly, Congressman Greg Murphy, M.D. (R-NC), highlighted the impact on patient care, noting, “Practices have had to hire many more staff just simply to fight with insurance companies. I am grateful for the collaborative effort by stakeholders to make commitments to streamline approvals and look forward to them delivering on this pledge.”
These private-sector reforms complement ongoing regulatory efforts by CMS designed to improve interoperability and efficiency within Medicare Advantage, Medicaid Managed Care, and the Health Insurance Marketplace®.
While expressing optimism about the collaborative progress, CMS affirmed its readiness to pursue additional regulatory actions to safeguard and enhance healthcare access if necessary.
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