One Year After Prior Authorization Pledge Changes Evident

In June 2025 a group of health insurers announced a six‑point pledge to overhaul prior authorization, but the promise carried no enforcement mechanism.

Insurers’ 2025 pledge: promises without teeth

According to the pledge, insurers would provide qualified clinical review of appeals, standardize electronic submissions, and enable real‑time approvals. The language sounded decisive, yet the commitments relied on self‑reporting and lacked any external audit.

Physicians’ Managing Editor Keith Reynolds asked Colin Banas, chief medical officer of DrFirst, why the industry appeared to rush the announcement. Banas recalled his own skepticism at the time, noting that “almost all the evidence that the pledge is working comes from the insurers who made it.”

That sentiment proved prescient. A year later, only a fraction of the promised improvements are evident in everyday practice.

What actually changed in the first year

When Banas reviewed each pillar, he found that merely 24 % of doctors reported receiving specialty‑matched review, a key metric the pledge highlighted. The reduction in authorization delays cited by insurers was based on internal data, not independent verification.

Two of the six commitments were already mandated by federal regulation, making the insurers’ credit‑taking appear redundant. “It feels like taking credit for something that you were going to have to do anyway,” Banas said.

Prior authorization friction now tops electronic health record (EHR) friction as the leading administrative complaint among clinicians. Practices still juggle fax machines, multiple browsers for different payers, and a fragmented workflow that Banas described as “a non‑unified, wasteful experience.”

Despite the setbacks, a handful of positive shifts emerged. Some payers introduced “gold‑card” programs that streamline approvals for high‑volume prescribers, and a modest number of patients reported smoother activation of their benefits.

For physicians on the front lines, the mixed results translate into a daily reality where waiting for an authorization can still feel like standing in line at a pharmacy counter, only to be told the prescription is “almost insanity.” The lingering delays suggest the system’s incentives have not fundamentally changed.

In practice, the limited progress means clinicians must continue to allocate staff time to chase approvals, often diverting resources from patient care. The promise of a smoother, electronic‑first process remains more aspirational than operational.

From a practical standpoint, the modest gains do ease some burdens, but the overall experience still resembles a half‑baked sandwich: parts are there, but the whole thing feels unfinished.

Road ahead: APIs and enforcement

Effective January 1 2027, a federal rule will require payers, EHR vendors, and even individual practices to meet enforceable standards. The rule mandates four specific application programming interfaces (APIs) that must connect insurers to providers in real time.

The APIs split the medical benefit and prescription benefit into separate tracks, meaning vendors must build two distinct data pipelines. Banas expects the deadline to strain under the weight of integration challenges, especially for smaller EHR vendors.

Enforcement will mirror the early years of the information blocking rule, where compliance lagged behind policy. “The pipes might get built, but if nobody monitors the flow, the bottleneck stays,” Banas warned.

Practices can take two immediate steps. First, they should request a clear compliance statement from their EHR or e‑prescribing vendor, confirming whether the required APIs are operational. Second, they need to start tracking approval times, denials, and reversals to establish a baseline for future comparison.

Both actions are free and can be implemented without additional software purchases. By gathering baseline data now, practices will be better positioned to demonstrate improvement—or lack thereof—once the 2027 deadline arrives.

In the meantime, Banas encourages clinicians to treat prior authorization transparency like a pizza tracker, where each stage of the process is visible to both provider and patient.

He plans to revisit the issue in six months, hoping to see whether the new federal requirements have shifted the setting from a “bad as ever” scenario to a more manageable workflow.