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A recent report published by Medscape Medical News examines the growing tension between health insurers promoting voluntary prior authorization (PA) reform and the physicians and policy researchers who say the effort lacks substance. America's Health Insurance Plans (AHIP), the insurance trade association, announced that leading insurers have eliminated 11% of PA requirements for medical services, representing 6.5 million fewer authorizations. However, AHIP declined to release the underlying survey data or identify which CPT codes were removed.
Critics were quick to point out the gaps. Sabin Dang, MD, a retinal specialist in St. Louis, called the announcement "frustratingly vague" and noted the 11% reduction excludes prescription drug authorizations, which he described as the area where patients face the most dangerous delays. In his own 2024 study of 2225 anti-VEGF drug requests, 96.2% were ultimately approved, yet nearly 60% remained unresolved after 24 hours and required a median of 100 minutes of staff time per request.
Darryl Drevna of the American Medical Group Association said the industry is "past the point of voluntary measures," calling for expedited decisions, transparency around clinical criteria, and Gold Card programs for high-performing providers. Kaye Pestaina of KFF observed that some insurers report removing PA for unnamed service codes while others reference vague reductions in "common" procedures. A 2025 KFF report found that 99% of Medicare Advantage enrollees are subject to PA for some services.
Brian Callaghan, MD, a neurologist at the University of Michigan, emphasized that medications remain the central PA burden and that omitting them from reform limits the impact of reform. Both Callaghan and Dang reported no noticeable reduction in day-to-day PA demands.
