10 prior authorization changes physicians should watch

Prior authorization is in the middle of its biggest overhaul in years.

Federal regulators have set faster decision deadlines, mandated electronic interfaces and required payers to publish their performance numbers. Roughly 60 commercial insurers signed a separate voluntary pledge in June 2025, promising to reduce the volume of services subject to prior authorization, honor existing approvals when patients switch plans, and, by 2027, answer most electronic prior authorization approvals in real time.

Physicians remain skeptical. Just 33% said they believe the insurer pledge will make a meaningful difference for patients and physicians, according to the 2025 American Medical Association (AMA) Prior Authorization Physician Survey, released Wednesday, May 13.

The survey of 1,000 practicing physicians, fielded in December 2025, found 95% reported that prior authorization delays access to necessary care, 79% said patients had abandoned recommended treatment because of authorization challenges, and 26% reported the process had led to a serious adverse event in their practice.

Related content: Prior auth reform: Physicians bemoan lots of promises but little progress

The track record is part of the reason. The AMA pointed out that a similar agreement in 2018 — the Consensus Statement on Improving the Prior Authorization Process — produced little measurable progress on the same kinds of commitments. Eighty-four percent of physicians in this year's survey said the number of prior authorization requests for prescription medications has increased over the past five years, and 74% said the number of denials has increased.

The regulatory machinery behind the 2025 commitments is real, however, and most of the binding pieces will hit physician practices in 2026 and 2027. CMS-0057-F, the Interoperability and Prior Authorization final rule, set faster decision timelines that took effect in January and a separate set of application programming interface requirements that go live Jan. 1, 2027. The agency announced 29 health systems, electronic health record (EHR) vendors, and other early adopters on May 13 to test the electronic workflows ahead of the deadline.

CMS has also proposed extending electronic prior authorization to drugs, and its WISeR model is expanding prior authorization into traditional Medicare in six states.

Above are 10 changes physicians should keep an eye on over the rest of 2026.

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