Published: 11/2/2026

ACP calls for improving prior authorization processes and reducing administrative burdens that negatively impact physicians, their patients, and the health care system as a whole.

ACTION:

ACP members can access members-only actionable materials.

Background

Prior authorization is a common practice of health insurers in which physicians must first secure approval before moving forward with a patient’s medications, tests, or procedures to ensure the insurer covers that care. This practice involves paperwork and phone calls, as well as varying data elements and submission mechanisms that can force physicians to enter unnecessary data in electronic health records (EHRs) or perform duplicative tasks outside of the clinical workflow.

ACP’s Patients Before Paperwork initiative and its 2017 position paper, Putting Patients First by Reducing Administrative Tasks in Health Care, call for reducing unnecessary administrative requirements that divert time and resources away from patient care.

Prior authorization remains one of the most burdensome administrative tasks in medicine. According to a 2025 AMA survey:

  • Physicians complete an average of 40 prior authorizations per week.
  • Physicians and staff spend an average of 13 hours weekly managing prior authorizations.
  • 88% reported increased healthcare resource utilization and waste associated with prior authorization requirements.
  • Approximately three-quarters reported prior authorization resulted in ineffective initial treatments or additional office visits.

Requirements for prior authorization can also create financial burdens for physicians, hospital systems, and other entities, such as needing to hire staff exclusively for this purpose. Studies estimate that prior authorization activities cost primary care practices between $2,161 and $3,430 annually per full-time physician.

Prior authorization requirements can also delay or interfere with patient care. In the 2025 AMA survey:

  • 95% of physicians reported delays in care due to prior authorization.
  • 79% reported patients sometimes abandoned recommended treatment because of delays.
  • 26% had seen prior authorization contribute to a serious adverse event.
  • 20% reported prior authorization contributed to a patient’s hospitalization.
  • 92% believed prior authorization negatively affected patient outcomes.

Federal Activity

ACP continues to advocate for federal legislation and regulatory reforms that improve prior authorization processes.

Legislative Advocacy:

ACP has submitted letters and submitted comments to House and Senate leaders outlining bipartisan policy bills  to address challenges across the health care system, including prior authorization reform. ACP supports the passage of the Improving Seniors’ Timely Access to Care Act, which would streamline the prior authorization process used to determine whether a prescribed procedure, service, or medication is covered by a health plan in Medicare Advantage (MA). ACP also supports broader reforms across other health insurance markets.

Regulatory Advocacy:

In addition to legislative advocacy, ACP has engaged in extensive regulatory advocacy to reduce the administrative burden caused by prior authorization. Recent efforts include:

  • Supporting CMS proposals to expand electronic prior authorization and improve transparency, timeliness, and interoperability for medication-related prior authorizations.
  • Providing feedback on the HHS WISeR Model and raising concerns about the use of AI and automated review processes that could affect patient access to care.
  • Supporting implementation of the 2024 CMS Interoperability and Prior Authorization Final Rule, which requires insurers to provide specific reasons for denials and meet established response timelines.
  • Advocating for stronger prior authorization protections in Medicare Advantage, Medicaid, and CHIP managed care programs.

Private Insurer Advocacy

In addition to working for public policy solutions, ACP also advocates directly with private insurers to call out particularly egregious prior authorization requirements. ACP joined other health organizations in a letter to United Healthcare, the largest private payer in the United States, urging them not to implement a prior authorization program for gastrointestinal endoscopy, raising concerns about the negative impacts for both patients and physicians. Direct feedback and stories from physicians, other health care professionals, and patients have often been key to successful prior authorization reforms. In August 2023, Cigna announced the removal of approximately 25% of medical services from prior authorization requirements, with plans to remove nearly 500 additional codes for Medicare Advantage (MA) plans by the end of 2023. In a statement on the removals, Cigna noted that “we’ve listened attentively to our clinician partners and are deliberately making these changes as a result.”

State Activity

While federal policymakers consider changes that would impact prior authorization processes across the country, a growing number of states are seeking to address the harm caused by prior authorization requirements with their own reforms. ACP is tracking more than 200 bills introduced across 40 states that would reform prior authorization requirements for procedures, diagnosis tests, treatments, and prescription medications.

Many proposals for prior authorization reform contain one or a combination of the following types of provisions:

  • Requirements on response time to requests (e.g., 24 hours for urgent, 48 hours for nonurgent requests)
  • Mandates that prior authorization requirements be evidence-based, such as peer-reviewed clinical data.
  • Requirements that denials are made by a physician of the same specialty.
  • Allowing authorizations to continue to be valid for medication dose changes or for ongoing management of chronic conditions.
  • Requirements for insurers to publicly release data on prior authorizations by different medications or services.
  • Restrict insurers from requiring other administrative burdens or related measures in addition to a prior authorization, such as step therapy protocols.

States have also considered “Gold Card” legislation that would exempt physicians with specific prior authorization approval rates over a period of time, typically six months, from prior authorization requirements on specified services. To date, states that have enacted gold card exemptions or similar pathways include Arkansas, Colorado, Louisiana, Texas, West Virginia, and Wyoming. As states experiment with gold card models, it remains somewhat unclear exactly what impact these programs are having on the overall administrative burdens of prior authorization, with limitations on what plans or specific services qualify for gold carding and some ACP members reporting that participation has been cumbersome.

Unless federal action is taken that sets new standards for all prior authorizations nationwide, laws and regulations will continue to vary from state to state. To see laws in your state as of 2024, please see this chart prepared by the AMA. 

References