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

Insurers may talk a good game about reforming prior authorizations, but most physicians don’t buy it.

Just one in three physicians believes a sweeping insurer pledge to reform prior authorization will produce meaningful change for patients or practices, according to new survey data from the American Medical Association (AMA).

The results don’t exist in a vacuum, but reflect years of unmet commitments from health plans on one of medicine's most persistent administrative burdens.

“Physician trust in voluntary insurer pledges is deeply eroded after years of unfulfilled promises,” said AMA President Bobby Mukkamala, M.D. “Physicians are especially frustrated when so-called peer-to-peer reviews are conducted by individuals who lack the appropriate clinical expertise to evaluate a patient’s care. When only a third of physicians expect meaningful impact — and so few report that health plan reviewers are appropriately qualified — it highlights a credibility gap that won’t be closed with vague or partial measures.”

Surveying skepticism

The 2025 AMA Prior Authorization Physician Survey, conducted in December 2025 among 1,000 practicing physicians, found deep skepticism about a June 2025 pledge signed by more than 60 health insurers to streamline and reduce prior authorization requirements. The pledge included six specific commitments with staggered implementation deadlines running through 2027.

Just 33% of physicians surveyed said they believe the latest insurer pledge will make a meaningful difference for patients and physicians. Patients appear equally doubtful: a July 2025 poll by KFF, a nonpartisan health policy research organization, found that only 39% of consumers believe insurers will follow through in a way that makes a difference.

Stop me if you’ve heard this one before

The AMA noted that a similar reform effort had already failed to deliver results. In January 2018, national organizations representing both health care professionals and insurers agreed to a Consensus Statement on Improving the Prior Authorization Process, which contained many of the same commitments included in the 2025 pledge. The survey found little progress on those earlier commitments. For example, 84% of physicians reported that the number of PA requests required for prescription medications has increased over the last five years, and 88% said PA interferes with continuity of care.

Who’s taking the call?

The most recent physicians' skepticism is grounded in what they report experiencing firsthand. The lone commitment that took effect at the time of the June 2025 pledge was a requirement that all denials based on medical necessity be reviewed by a licensed and qualified clinician. Yet only one in four physicians (24%) said such reviews are being consistently conducted by appropriately qualified clinicians.

Among physicians who have participated in peer-to-peer reviews, speaking directly with a health plan representative to challenge a denial, only 16% said the health plan's representative often or always had the appropriate qualifications.

Delays, harm, and abandoned treatment

The survey documented that physicians reported widespread patient harm attributed to prior authorization.

• 26% reported that PA has led to a serious adverse event for a patient in their care, including hospitalization, permanent impairment, or death.
• 20% of physicians said PA has led to a patient's hospitalization
• 22% reported it has led to a life-threatening event or required intervention to prevent permanent impairment or damage
• 8% said it has led to a patient's disability, permanent bodily damage, or death.

Delayed care was nearly universal:

• 95% of physicians said prior authorization delays access to necessary care
• 92% said it negatively affects clinical outcomes overall.
• 79% reported that patients abandon recommended treatment because of prior authorization challenges

More than one in three physicians (35%) also reported that PA criteria are rarely or never based on clinical evidence, raising questions about the medical rationale underlying many denials.

A crushing administrative load

Beyond patient harm, the survey quantified the administrative weight prior authorization places on physician practices. On average, physicians complete 40 prior authorization requests per week, and physicians and their staff spend an average of 13 hours per week managing the process. Two in five physicians (40%) said they employ staff dedicated exclusively to prior authorization tasks.

Nearly one in three physicians (32%) reported that their PA requests are often or always denied. Despite that denial rate, many physicians do not routinely appeal:

• 59% said they don't appeal because past experience tells them it won't succeed.
• 52% cited insufficient staff time.
• 49% said patient care simply cannot wait for the health plan to respond.

The administrative strain is compounding another crisis: 94% of physicians said prior authorization somewhat or significantly contributes to physician burnout. Three-quarters of respondents (74%) reported that denials have increased over the past five years. Looking ahead, 60% said they are concerned that the growing use of augmented intelligence — AI-assisted decision-making tools — by insurers will further increase denial rates.

Compounding costs, unneeded care

Prior authorization also generates waste beyond the physician's office. A full 88% of physicians said PA increases overall health care utilization rather than containing it. Doctors cited ineffective initial treatments forced by step therapy requirements (75%), additional office visits (73%), urgent or emergency care visits (47%), and hospitalizations (32%) as downstream consequences of PA requirements.

The AMA said it will continue working with the Trump administration, Congress, and health insurers to advance prior authorization reforms. Additional resources are available at FixPriorAuth.org.

“Rebuilding trust will require sustained, transparent, and measurable action to streamline prior authorization and keep it clinically focused and patient-centered,” Mukkamala said. “Anything less risks reinforcing the skepticism these pledges were meant to address.”