HHS and Insurers Announce Voluntary Pledge to Cut Prior-authorization Burdens, Aim for Real-time Decisions by 2027

Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, said at an HHS press conference that major health insurers and hospital systems have agreed to a voluntary pledge to reduce the burden of prior authorization on patients and providers.

The pledge, Oz said, will emphasize three priorities: faster access to care, administrative efficiency and transparency. "Patients should not be waiting because bureaucratic hurdles are blocking their critical treatment," Oz said, describing industry commitments to standardize processes, adopt electronic prior-authorization standards and publish public performance dashboards.

Why it matters: Officials and industry representatives told reporters the change targets a widely reported problem that delays care and adds large administrative costs. Oz said about 68,000,000 people are in the Medicare population, roughly half in Medicare Advantage plans, and that Medicare Advantage initial prior-authorization requests last year led to roughly 3,200,000 partial or full denials. Physicians, Oz and others said, commonly spend roughly 12 hours a week on paperwork related to prior authorization.

What the pledge would do: Administration officials described several concrete elements. CMS will publish the list of participating plans "later this summer," they said. Insurers have agreed to work toward fewer codes requiring prior authorization, to adopt electronic data standards based on FHIR (Fast Healthcare Interoperability Resources), and to provide public metrics on timeliness and adherence. Chris Klomp, Director of Medicare for CMS, said metrics and adherence data should be available on the AHIP website and at CMS.

Targets and timeline: Officials told reporters the initiative is voluntary but backed by deadlines and metrics. CMS and industry leaders set a goal that most electronic prior-authorization requests will be adjudicated in real time by 2027; administration officials said a specific operational target is that at least 80 percent of prior-authorization requirements should be adjudicated in real time at the point of care by Jan. 1, 2027. They also discussed a goal of 90-day continuity of authorizations when patients switch insurers.

Scope and coverage: Secretary Kennedy said the companies in the initial meeting collectively cover roughly 257,000,000 people across Medicare Advantage, Medicaid and commercial insurance, and he said additional firms joined while the meeting was underway. CMS officials and insurers said participation is voluntary; both Secretary Kennedy and Oz said the government retains tools to intervene through CMS rulemaking or legislation if voluntary compliance falls short. "We need to trust but verify," Oz said.

Standards and interoperability: CMS staff emphasized interoperability and a single FHIR-based electronic workflow so systems can exchange information and reduce faxes and manual calls. Officials said more than half of prior-authorizations today rely on phones or faxes and that standardization of protocols will be necessary for real-time adjudication and reliable public reporting.

Voices from patients and clinicians: Actor Eric Dane, who said he is a patient with amyotrophic lateral sclerosis (ALS), praised the effort. "Anything we can do to give patients more certainty with fewer delays is a worthwhile endeavor," Dane said. Several physician-lawmakers at the event—Senator Marshall and U.S. Rep. Greg Murphy—urged accountability and quicker peer-to-peer clinical review processes, and emphasized that the proof will be whether insurers follow through.

Limits and oversight: Officials repeatedly noted the pledge is not a regulation. Secretary Kennedy described prior failed industry commitments and said this effort includes specified metrics, deliverables and oversight to improve compliance. CMS staff said they are preparing rulemaking and other enforcement options that could be used if the voluntary approach does not deliver results.

Next steps: CMS will publish participating plans and initial implementation details "later this summer," officials said. Industry leaders and CMS staff will work on interoperability, code reductions and measuring timeliness; CMS said it expects rolling enrollment of additional plans and that some measures should be visible to the public within months.

The announcement frames the pledge as the administration's first step toward broader administrative simplification intended to reduce paperwork, expand electronic workflows and support a shift toward value- and outcome-based care.