Source: Forbes
Health insurance companies are expected to hold to their promises in 2026 to “streamline, simplify and reduce” prior authorization, the process of insurers reviewing hospital admissions and medications.
Last summer, the biggest names in health insurance, including Cigna, CVS Health’s Aetna, UnitedHealth Group’s UnitedHealthcare and Humana were among more than 50 health insurers committing to reducing prior authorization along with simplifying business practices in general.
The sweeping commitments were announced by America’s Health Insurance Plans, also known as AHIP, and the Blue Cross Blue Shield Association. These groups and their health plan members, which provide health benefits to more than 250 million Americans, said they “aim to accelerate decision timelines, increase transparency and expand access to affordable, quality care.”
Doctors complain prior authorization has delayed needed treatment and put patient health in jeopardy while wasting physician and patient time to jump through hoops. Over the past several years, prior authorization increasingly has become a concern for patient access to needed services, according to almost 30% of physicians responding to an American Medical Association survey in 2023.
But doctors and their patients should already be seeing changes early this year as more and more health insurance companies, as well as pharmacy benefit managers (PBMs) that approve their prescriptions, say they are eliminating hurdles to care and medications.
Take OptumRx, which is the PBM owned by UnitedHealth Group. One of the nation’s three largest PBMs, OptumRx is ahead of a goal and announced last year to reduce prior authorizations by up to 25% of prescriptions in the PBM’s list of drugs known as a formulary. This has amounted to scores of prescription medications to treat an array of diseases and chronic conditions.
“On prior authorization, (we’re) actually getting rid of 25% where it’s no longer clinically necessary and taking prior authorization that used to take eight hours on average to less than 10 seconds using AI and technology,” Dr. Patrick Conway, the chief executive officer of Optum, parent of OptumRx, said last month at the annual Forbes Healthcare Summit, held at NYU Langone Health in New York.
