U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz met Monday with industry leaders to discuss their pledge to streamline and improve the prior authorization processes for Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace® and commercial plans covering nearly eight out of 10 Americans, according to a news release.
In a roundtable discussion hosted by HHS, health insurers pledged six key reforms aimed at cutting red tape, accelerating care decisions, and enhancing transparency for patients and providers. Their commitments reinforce the role of CMS in monitoring outcomes and promoting accountability. Companies represented at the roundtable included Aetna, Inc., AHIP, Blue Cross Blue Shield Association, CareFirst BlueCross BlueShield, Centene Corporation, The Cigna Group, Elevance Health, GuideWell, Highmark Health, Humana, Inc., Kaiser Permanente, and UnitedHealthcare.
“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,” said 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.”
“These commitments represent a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care,” said Administrator Oz. “We applaud these voluntary actions by the private sector, which is how these types of issues should be solved. CMS will be evaluating progress and driving accountability toward our shared goals, as we continue to champion solutions that put patients first."
Participating health insurers have pledged to:
- Standardize electronic prior authorization submissions using Fast Healthcare Interoperability Resources (FHIR®)-based application programming interfaces.
- Reduce the volume of medical services subject to prior authorization by January 1, 2026.
- Honor existing authorizations during insurance transitions to ensure continuity of care.
- Enhance transparency and communication around authorization decisions and appeals.
- Expand real-time responses to minimize delays in care with real-time approvals for most requests by 2027.
- Ensure medical professionals review all clinical denials.
Praise from members of Congress regarding today’s developments:
“It was an honor to attend this discussion with Secretary Kennedy and CMS Administrator Dr. Oz,” U.S. Senator Roger Marshall, M.D. (R-KS) said. “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.”
“Thank you to President Trump, Secretary Kennedy, and Administrator Oz for working to improve the prior authorization process for American patients,” Congressman Greg Murphy, M.D. (R-NC) and co-chair of the House GOP Doctors Caucus, said. “As a physician for over 30 years, I witnessed the ridiculous and ever-increasing obstructions caused by insurance companies to delay or deny care to patients. These bureaucratic hurdles end up hurting patients and those who care for them. Practices have had to hire many more staff just simply to fight with insurance companies. I have made reform a top priority of mine since coming to Congress. 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 to improve prior authorization interoperability within Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace®.
CMS encourages continued innovation and collaboration but reserves the right to pursue additional regulatory actions if necessary.
