Do payers respond to your prior authorization requests within seven days? Are you able to get expedited responses (for emergencies) from insurance companies within 72 hours? When payers deny coverage, do they give you clear reasoning why the service is being denied?

In theory, the answer to all these questions should now be yes (at least for plans in categories of insurance regulated by the federal government such as Medicare Advantage, Medicaid Managed Care, and the Affordable Care Act). This is because, as of 2026, new regulations to improve prior authorization are now in effect.

The new prior authorization rules were first finalized by the Biden Administration in 2024, and the Trump Administration has not sought to reverse or rescind these rules. In June 2025, Health and Human Services (HHS) Secretary Robert F Kennedy, Jr., and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz announced to great fanfare that they have secured an industry pledge from all the major commercial plans to fix a “broken prior authorization system.”

Specifically, the health insurers pledged to:

• Standardize electronic authorization submissions using Fast Healthcare Interoperability Resource (FHIR)-based application programing interfaces (by 2027).
• Reduce the volume of medical services subject to prior authorization by January 1, 2026.
• Honor existing authorizations during insurance transitions to ensure continuity of care.
• Enhance transparency and communication around authorization decisions and appeals.
• Expand real-time responses to minimize delays in care with real-time approvals for most requests by 2027.
• Ensure medical professionals review all clinical denials.

A cynic might argue that this pledge to improve prior authorization is just a ploy by the payers to take away political momentum for more substantive legislative reforms on the matter. Indeed, prior authorization is used by insurers to keep their costs down and margins healthy, so it seems suspect that the insurers would willingly give away such a valuable tool for their businesses. Perhaps it is all just a delay tactic as similar promises to improve prior authorization were made by the insurance industry in 2018 with little to no follow through.

But I think we should also consider that the insurance industry may genuinely want to improve prior authorization. Simplifying and streamlining authorization may stand to benefit both payers and providers who are increasingly spending more resources (often augmented by AI) in bureaucratic fights with each other over coverage decisions. Furthermore, fighting to preserve an unpopular practice with patients, providers, and politicians is frankly a bad use of their political capital when they have plenty of other issues before Congress.

Putting aside the motives of the insurance industry, the fact remains that on paper, prior authorization should be getting significantly easier for providers to navigate in 2026. This is good news!

But just because there are federal rules now in effect, this does not mean that the reality of the situation will instantly change. Both the Biden rule and the payers’ promises will need to be thoroughly implemented if they are to mean anything.

Will the federally regulated plans meet their timelines, and will CMS aggressively enforce penalties on plans that don’t meet the regulation? Will payers live up to their promise and demonstrably reduce the number of procedures subject to prior authorization? These are questions that I cannot answer right now, but we should find out very soon if these reforms are actually going to take hold.

I, for one, am hopeful that prior authorization can be reined in responsibly, such that it is only rarely used by payers to prevent egregious healthcare overspending. Easier said than done, I know. Yet against the backdrop of the major and contentious healthcare policy reforms and debates stemming from the One Big Beautiful Bill and the expiration of the enhanced Affordable Care Act (ACA) subsidies, prior authorization reform is one area where we may actually have consensus across both parties and industry stakeholders. The federal rules are in effect, the industry promises have been made, and there can be no more excuses. Now is the time to implement these policies and finally fix the broken prior authorization process.