Context:

The Trump administration has secured a pledge from approximately 75% of health insurers to improve patient care by addressing the cumbersome prior-authorization process. This voluntary commitment, announced by Dr. Mehmet Oz and Robert F. Kennedy Jr., aims to streamline procedures that have been criticized for delaying care and increasing bureaucratic burdens on healthcare providers. By 2027, the initiative seeks to establish a standardized electronic prior-authorization system to expedite approvals, with 80% expected to be processed in real-time. Additionally, insurers have agreed to honor existing prior-authorization approvals for 90 days when patients switch providers, and to provide clear explanations and appeals guidance. This collaborative effort among insurers is expected to enhance patient access to care, although it may impact their profitability if patients seek care more frequently as a result.

Dive Deeper:

• The Trump administration, through Dr. Mehmet Oz and Robert F. Kennedy Jr., announced a new pledge from about 75% of health insurers aimed at reducing bureaucratic hurdles in patient care, specifically targeting the cumbersome prior-authorization process.

• This industry-led pledge is voluntary and not legislated, but it represents a substantial commitment to reform a process that has been widely criticized for causing significant delays in patient care and imposing burdens on healthcare providers.

• The initiative includes the development of a standardized electronic prior-authorization system, with a goal to have it operational by January 1, 2027, and aims for 80% of electronic approvals to be processed in real-time.

• Insurers have also committed to honoring existing prior-authorization approvals for 90 days when patients change insurance providers, starting by January 1, 2026, to ensure continuity of care during transitions.

• Transparency is a key component of the pledge, with insurers required to provide clear and easy-to-understand explanations of prior-authorization determinations, including guidance for appeals.

• While the pledge is expected to improve patient access to care, it may also impact the profitability of insurance companies if patients begin to seek care more frequently due to reduced administrative barriers.

• Dr. Oz highlighted the collaborative nature of this effort, likening it to a biblical principle where competitors agree to set aside differences to achieve a common good, emphasizing the need for collective action to solve the pervasive issue in healthcare.