State Legislators Target Prior Authorization

People hate to wait in line. So is it any wonder that this year state legislators have targeted prior authorization, the policy mandating that patients wait for medical services until insurance companies sign off on them?

Long derided by both patients and physicians alike, prior authorization raises the stakes on our natural, human dislike of uncertainty by combining it with a major source of our modern anxieties, our health.

Not that prior authorization isn’t a matter of grave, substantive concern to many. While health plans and benefit managers insist that prior authorization is necessary to control spiraling medical costs, a recent survey by the American Medical Association found that 93% of doctors report that prior authorization delays necessary care and 82% believe it at least sometimes causes patients to forego treatment.

“The prior authorization process itself feels outdated, relying on faxed forms and peer-to-peer phone calls between highly trained specialists and insurance employees who may lack relevant clinical expertise but whose judgments override those of the physician,” wrote Jihad Abdelgadir and Gabriela Plasencia in a June 2025 piece of commentary published by the nonprofit research organization RAND entitled “The Health Care System Is Broken—and Prior Authorization Is a Big Part of the Problem.” “If the call is missed or the fax does not go through, the request is denied. The patient must then wait, pay out of pocket, or give up.”

Prior Authorization Bills Enacted in Over Half of States

Lawmakers in at least 43 states introduced legislation dealing substantively with prior authorization this year, according to LexisNexis State Net legislative tracking system. Such measures were enacted in 28 of those states.

Different Approaches to Prior Authorization Reform

Like several of his state legislative colleagues across the country, California Sen. John Becker (D) championed a bill this year aimed at reforming the prior authorization process. His bill, SB 306, would bar prior authorization for any service that is approved more than 90% of the time. The bill sailed through the state’s Legislature virtually unopposed and now awaits action by Gov. Gavin Newsom (D).

“Unnecessary delays for medically necessary treatments remain one of the biggest barriers to access to health care,” Becker said in February when he introduced SB 306. “With this bill, I am tackling one of the most frustrating and wasteful hurdles in our health care system—burdensome insurance company reviews over medical services that are nearly always approved. By removing these superfluous barriers, we can give doctors more time to treat patients instead of pushing paperwork and driving up costs.”

Becker’s legislation represents one of several approaches states have taken with prior authorization bills this year.

• Arizona enacted HB 2175, by Rep. Julie Willoughby (R), which mandates discrete steps insurance companies have to take if they deny a claim during the utilization review process, including ensuring their medical directors individually review the denial.

• Indiana enacted SB 480, by Sens. Tyler Johnson (R), Ed Charbonneau (R) and Liz Brown (R), prohibiting utilization reviews from denying services on prior authorization solely due to the referring provider being out of network.

• Maine enacted SB 14, by Sen. Donna Bailey (D), barring insurance companies from requiring ground ambulance services to obtain prior authorization before transporting a patient to a hospital, between hospitals or from a hospital to a nursing home, hospice care facility or other facilities. It also prohibits insurance companies from requiring air ambulances for nonprofits to obtain prior authorization for taking a patient to a hospital or between hospitals for urgent care.

• Montana enacted SB 447, by Sen. Vince Ricci (R), which prohibits prior authorization for certain prescriptions and declares that prior authorization for a chronic condition is valid for the length of the condition.

In all, at least 59 bills dealing substantively with prior authorization have been enacted in 28 states this year, according to the LexisNexis® State Net® legislative tracking system. Another 48 prior authorization bills are still pending in 8 states, underscoring what a priority this issue has become in many state capitols in 2025.

Insurer’s Perspective on Prior Authorization

While prior authorization has drawn criticism from physicians and patients, insurers maintain that the process plays a critical role in helping to control healthcare costs, ensure appropriate care and prevent overutilization and fraud.

This past summer some of the nation’s biggest health insurers, including Cigna, UnitedHealthcare and Blue Cross Blue Shield, also committed to “streamline, simplify and reduce” the prior authorization process.

“Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system,” Mike Tuffin, president and CEO of the trade group AHIP, formerly America’s Health Insurance Plans, said in a statement.

Insurers have sought to use technology, including artificial intelligence, to help reduce delays and lower the administrative burden associated with the prior authorization process as well. In fact, Cigna and UnitedHealthcare are facing lawsuits over their alleged use of AI to “systematically deny care to patients,” according to a report by Politico in early September.

But that article also pointed out that in January 2026, the Centers for Medicare and Medicaid Services will be launching a pilot program that will test whether AI can improve efficiency and accuracy in determining coverage for Medicare patients in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington.

It remains to be seen, however, whether insurers’ own reform efforts or AI will stop the flow of bills like those from Becker and others targeting prior authorization.

—By SNCJ Correspondent BRIAN JOSEPH

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