AHA Supports Administration Facilitating Health Insurer Pledge to Reform Prior Authorization

September 29, 2025

The Honorable Robert F. Kennedy Jr. 
Secretary
Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, DC 20201

The Honorable Mehmet Oz, M.D.
Administrator
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850

Re: Health Insurer Commitment to Improved Prior Authorization Processes

Dear Secretary Kennedy and Administrator Oz:

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) thanks you for your role in facilitating the health insurer pledge to reform prior authorization processes announced on June 23.

The AHA commends the administration for convening health insurance industry leadership and enabling their potentially transformative reform commitments. By establishing a shared and measurable commitment to improving prior authorization processes through standardization, volume reductions and minimizing care delays and disruptions, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) have empowered plans and providers to collaboratively transform care delivery and improve patient health outcomes. The insurance industry’s commitments also have the potential to significantly reduce administrative burden on providers. We offer the following insights and recommendations to ensure the pledge achieves these important outcomes.

Additionally, we thank the administration and the Assistant Secretary for Technology Policy/Office of the National Coordinator (ASTP/ONC) for establishing new certification criteria to support electronic prior authorization within the Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization (HTI-4) final rule. The AHA strongly supports an end-to-end automated prior authorization process that integrates with clinicians’ electronic health records workflow. The ASTP/ONC certification criteria will bridge the gap between payer and provider systems and enable the successful exchange of the essential information needed to streamline prior authorizations.

As you recognized in the announcement of this pledge, prior authorization is too often used in a manner that leads to dangerous delays in treatment, clinician burnout and waste in the health care system. Prior authorization requirements often delay patient access to necessary care or lead to treatment abandonment, thereby worsening health outcomes and putting patients at risk. The process places an especially heavy burden on those with chronic or serious conditions.¹ In response to a recent AHA member survey, 95% of hospitals and health systems reported that the amount of staff time spent seeking prior authorization approval from health plans has increased in the last year. And the resource-intensive staff time spent managing health policies adds tremendous cost and burden to the health care system, including an estimated $26.7 billion spent by providers each year.² Moreover, the administrative delays and denials associated with prior authorization can intensify patient frustration, which in some cases has escalated into hostility toward health care workers. Our member hospitals note that the burdens of prior authorization contribute to heightened tensions in clinical settings, placing medical staff at increased risk of workplace violence.

As a result of the enormous detrimental impact that certain prior authorization practices routinely place on patients, physicians and hospitals, the AHA has been actively pushing for reforms in this area for a long time and working with health plans to collaboratively reduce the burdens associated with these programs.³ In 2018, the AHA signed a joint consensus statement with AHIP, Blue Cross Blue Shield Association, the American Medical Association, the American Pharmacists Association, and the Medical Group Management Association in which the participants agreed to pursue a reduction in prior authorization volume, increase programmatic transparency, implement protections with continuity of care for patients, and establish standardized methods of completing prior authorizations.

However, despite the commitments expressed in the 2018 consensus statement, providers have seen minimal voluntary reforms by commercial plans. Prior authorization volume has continued to increase, patients continue to experience care disruptions when switching plans, the medical criteria used to process authorizations are still not clear for providers and prior authorization processes remain fractured. Therefore, we encourage CMS to actively monitor plans’ progress to ensure they honor these commitments, including full implementation of existing regulations such as the Interoperability and Prior Authorization final rule and reforms issued in the 2024 Medicare Advantage final rule. In addition, attached we offer more detailed recommendations for areas of oversight that warrant particular focus based on our members’ experience.

We thank you again for your timely focus on this critically important issue. Please feel free to contact me if you have any questions or have a member of your team contact Terrence Cunningham, AHA’s senior director of administrative simplification policy, at tcunningham@aha.org.

Sincerely,
/s/
Richard J. Pollack 
President and Chief Executive Officer

Attachment A: Recommendations to Oversee and Track Health Insurance Plans’ Pledge to Reform Prior Authorization Practices

View the letter and detailed attachment below. 

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¹ https://www.kff.org/affordable-care-act/consumer-problems-with-prior-authorization-evidence-from-kff-survey/ 
² https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.00036 
³ More information about AHA resources on prior authorization and health plan accountability can be found at: https://www.aha.org/issue-landing-page/2024-01-22-health-plan-accountability