Full Breakdown
Insurers Accelerate Standardization of Prior Authorization to Reduce Care Delays
4/25/2026, 9:01:31 PM
Commitment and Timeline
Fifty health plans—including UnitedHealthcare, Aetna, Cigna, Elevance Health, Centene, Humana and CVS Health’s Aetna—pledged to standardize electronic prior-authorization for high-volume services such as orthopedic surgery, CT and MRI. The plan, with HHS and CMS, targets over 70 % of PA volume by end-2026 for UnitedHealthcare and Cigna; Aetna reports 88 % standardized. AHIP and the Blue Cross Blue Shield Association set a Jan. 1 2027 deadline.
Background and Rationale
Providers say PA can delay care and add paperwork. Congressional scrutiny has risen, with a House panel set to question health-system leaders on affordability and access. The pledge seeks to streamline PA, improve transparency and enable electronic approvals.
Key Insurers and Stakeholders
Signatories include UnitedHealthcare (UnitedHealth Group), Aetna (CVS Health), Cigna Group, Elevance Health, Centene, Humana, plus AHIP, the Blue Cross Blue Shield Association, and federal partners HHS and CMS.
Progress Data
UnitedHealthcare has standardized half its PA volume, targeting 70 % by year-end. Aetna reports 88 % standardized and >95 % of requests approved within 24 hours. AHIP notes an 11 % drop—about 6.5 million fewer PA requests—and a 15 % cut in Medicare Advantage. Cigna reduced PA volume by 15 %. Real-time processing now exceeds 83 % of requests, above the 80 % 2027 target.
Official Statements Summary
CMS administrator Mehmet Oz called the pledge a “meaningful step forward” for faster patient answers. AHIP President Mike Tuffin said the standardized approach will deliver quicker, more consistent decisions. Aetna President Steve Nelson stressed speed, transparency and clinical judgment. Cigna’s Amy Flaster reiterated the goal of freeing clinicians from paperwork.
Criticism and Provider Concerns
Providers warn PA may still block timely care, questioning whether reforms will yield measurable gains. The upcoming House hearing reflects legislative skepticism.
Conflicting Metrics
Insurers report varied targets—Aetna at 88 %, UnitedHealthcare and Cigna at 70 % by year-end, and AHIP’s 2027 goal of 80 % real-time approvals—showing a fragmented progress picture.
Verbatim Quotes
- “This is a meaningful step forward toward giving patients faster answers, more certainty, and fewer unnecessary delays in care,” — Mehmet Oz, Administrator, CMS
- “We want patients to get the care they need when they need it, and we want doctors and their teams to be able to focus on patients – not paperwork,” — Dr. Amy Flaster, Chief Medical Officer, Cigna Group
- “As more providers adopt electronic prior authorization, this standardized approach will mean faster answers for patients, a more consistent experience for providers and less friction for everyone,” — Mike Tuffin, President and CEO, AHIP
- “Prior authorization should enable care, not delay it. We’re modernizing the process with speed, transparency, and clinical judgment to benefit everyone we serve.” — Steve Nelson, President, Aetna
What's Next
The House panel on health-care affordability will interview health-system leaders next week, potentially shaping further regulation. Insurers plan to add more services to the standardized list, integrate pharmacy decisions into single reviews, and target at least 80 % of PA requests processed in real time by 2027.
