UnitedHealth Group and CVS Health have standardized data and submission rules for more than half of their prior authorizations, the two health insurance giants said, in the latest concession to mounting pressure on US carriers to ease the paperwork burden choking patients and physicians.
The move lands amid a regulatory and political squeeze that shows no sign of letting up. UnitedHealth, CVS and their peers have spent the past year trying to deliver on a sweeping set of commitments to cut friction in approvals for drugs and medical services.
Sector-wide, prior authorization volumes fell 11% over a 10-month stretch, wiping out 6.5 million transactions, with Medicare Advantage usage dropping more than 15%. Carriers have also agreed to honor existing approvals for 90 days when policyholders switch plans.
The pledges cover insurers serving more than 250 million Americans, with real-time decisions promised by 2027.
The voluntary push sits inside a hardening federal frame. CMS finalized its Interoperability and Prior Authorization rule in January 2024, forcing Medicare Advantage, Medicaid and ACA marketplace plans to clear urgent requests within 72 hours and standard ones within seven days, with most provisions kicking in this year.
The agency has pegged the savings at roughly $15 billion over a decade.
The pressure has only sharpened. CMS proposed earlier this month to extend electronic prior authorization to drugs covered under medical benefits, with 24-hour turnarounds for urgent cases.
Health Secretary Robert F. Kennedy Jr. has said the administration extracted agreement from 80% of the industry last year to drop prior authorization for common services such as imaging, physical therapy and outpatient surgery — and has hinted at regulation if carriers fall short.
The June 2025 commitment – convened by AHIP and the Blue Cross Blue Shield Association, and previously reported – drew in more than 60 insurers, the American Medical Association has noted, reaching some 257 million Americans across commercial, Medicare Advantage and Medicaid managed care.
The six-point pledge runs from standardized electronic submissions via FHIR APIs by 2027, a narrower list of services subject to review, the 90-day continuity guarantee, clearer denial explanations, real-time approvals for at least 80% of electronic requests, and medical professional review of all clinical denials.
Doctors are not yet sold. AMA president Bobby Mukkamala has said the group will watch implementation closely, while industry observers have noted that a similar 2018 pledge delivered little.
UnitedHealthcare expects more than 70% of its prior authorization requests to run through the standardized process by year-end, across commercial, Medicare Advantage and Medicaid lines. Coverage rules and clinical criteria, the health insurance arm stressed, will not change.
Aetna, the CVS Health unit, is further down the road at 88%. AHIP says the program will tackle services that have long bred friction, including orthopedic surgeries and imaging such as CT scans and MRIs.
