Health Care
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Health Care
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Insurers step up prior authorization reforms |
Major health insurance companies on Friday said they were accelerating efforts to streamline prior authorization requirements and reduce administrative burdens for providers.
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The commitment was signed by about 50 companies, including UnitedHealthcare, Aetna and Cigna. It comes as insurers face mounting scrutiny on Capitol Hill for prior authorization practices that providers argue can delay or block necessary care.
Under the new agreement, participating plans are adopting a standardized approach for providers submitting electronic prior authorization requests for services such as orthopedic surgeries and imaging like CT scans and MRIs.
These services span commercial coverage, Medicare Advantage and Medicaid managed care.
UnitedHealthcare said more than half of its prior authorization volume will be incorporated into the standardization process, with that share expected to exceed 70 percent by the end of 2026.
The announcement could help insurers cast themselves as stewards of affordability, helping to keep providers from ordering unnecessary services — and keeping facilities from getting paid for them.
A House panel is set to grill health system executives next week on health care affordability.
“This is a meaningful step forward toward giving patients faster answers, more certainty, and fewer unnecessary delays in care,” Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, wrote on X. “I applaud these efforts from a collection of the largest health plans across most market segments as momentum builds. We look forward to continuing to work with health plans and providers on improving care for patients through this effort.
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Welcome to The Hill’s Health Care newsletter, we're Nathaniel Weixel and Joseph Choi — every week we follow the latest moves on how Washington impacts your health.
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How policy will be impacting the health care sector this week and beyond:
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The Food and Drug Administration (FDA) on Friday granted fast-track review to three companies studying psychedelic therapies to treat depression and post-traumatic stress disorder (PTSD), the latest step by the Trump administration toward possible approval. The agency did not disclose the specific companies that were granted priority review vouchers. Two companies are studying psilocybin; one for treatment-resistant depression (TRD) and …
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Acting Attorney General Todd Blanche signed an order Thursday to reclassify state-licensed medical marijuana as a less dangerous drug. The order shifts the designation of licensed medical marijuana from a high level of regulation to a much looser level. It also provides a tax break to licensed medical marijuana operators. This move does not legalize marijuana use under federal law, but it will impact the 40 states that have …
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President Trump unveiled a deal with drugmaker Regeneron on Thursday for the company to voluntarily cut prices, the final manufacturer to commit to the White House’s “most favored nation” plan to lower U.S. costs in line with other developed nations. Under the agreement, Regeneron said it will reduce prices for its current and future medications sold to Medicaid. It will also offer its cholesterol …
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Branch out with a different read:
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Cotton: Change to marijuana drug classification ‘a step in the wrong direction’
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Sen. Tom Cotton (R-Ark.) on Thursday criticized the Department of Justice’s (DOJ) decision to downgrade state-approved medical marijuana to a less dangerous drug. “Marijuana today is much more potent than just ten or twenty years ago, leading to increased psychosis, anti-social behavior, and fatal car crashes,” Cotton wrote on the social platform X. “Arkansans don’t want more dangerous drugs obtained more easily,” he continued. …
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Local and state headlines on health care:
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- Medical marijuana reclassification impact in Pennsylvania remains to be seen, state says (LancasterOnline)
- Mississippi lab temporarily outsources some public health testing services (Mississippi Today)
- Josh Hawley calls on RFK Jr. to end Title X family planning funds to Missouri’s sole grantee (Missouri Independent)
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Health news we've flagged from other outlets:
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- Newer testing methods suggest significant silent spread of measles in the US, threatening elimination (CNN)
- Growing use of guest editors has turned some journals into a ‘playground of bad science’ (Stat)
- A ‘barbaric’ problem in American hospitals is only getting bigger (KFF Health News)
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Opinions related to health submitted to The Hill:
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You're all caught up. See you next week!
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