Leading Corporations Endorse CMS Prior Authorization Modernization Initiative

Five major employers—Amazon, Axon Enterprise, Google, Meta, and Oracle Corporation—have signed a statement of support to expand electronic prior authorization to self-funded health plans, the Centers for Medicare and Medicaid Services announced on Wednesday. The effort aims to reduce manual administrative work and prevent delays in patient care.

The initiative is part of the 2025 Prior Authorization Pledge from the federal government and major insurers to improve prior authorization. HHS Secretary Robert F. Kennedy Jr. stated that prior authorization should help patients get the right care, not trap doctors and families in administrative delays. Under President Trump, HHS is cutting unnecessary bureaucracy, modernizing how health plans make coverage decisions, and expanding these reforms to millions of Americans in self-funded plans.

Self-funded employers often outsource health benefit administration, including prior authorization, to third-party administrators and other vendors. More than half of Americans receive health coverage through their employers.

The announcement stated that CMS and the Department of Labor are working together to bring prior authorization reform to the self-funded market. The DOL’s Employee Benefits Security Administration is working directly with self-funded health plans.

“The departments appreciate these U.S. companies for stepping forward to collaborate with Labor and Health and Human Services to help employees cut through red tape and receive their health benefits,” said Assistant Secretary for the Employee Benefits Security Administration Daniel Aronowitz. “By signing this statement of support for the expansion of electronic prior authorization reform, government and private industry are working together on behalf of the American workforce.”

Through the Prior Authorization Pledge, insurers are also working to reduce prior authorization requirements for certain claims and ensure continuity of care when patients switch plans. In addition, payers are improving communication and transparency on prior authorization decisions.

The payers that signed on to the commitments include UnitedHealthcare, Elevance Health, Aetna, Cigna and more.

In April, data showed that health insurers have reduced prior authorizations by 11% since announcing the commitments. In Medicare Advantage, prior authorizations were down 15%.

CMS’ Interoperability and Prior Authorization Final Rule also requires certain insurers to implement electronic prior authorization starting January 1.

“Patients and doctors shouldn’t have to fall back on faxes and paperwork simply because of how a patient’s health plan is funded,” said CMS Administrator Dr. Mehmet Oz. “We’ve brought insurers, providers, and technology companies to the table to modernize prior authorization, and now employers are helping us take another important step. When the entire healthcare system moves together, we can spend less time on paperwork and more time getting patients the care they need.”

Source link