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RFK Jr Secures Pledge from Insurers to Streamline Prior Authorization Practices

RFK Jr Secures Pledge from Insurers to Streamline Prior Authorization Practices

Let’s hope these voluntary reforms are helpful and have staying power.

In just a few short months at the helm of the Department of Health and Human Services (HHS), Secretary Robert F. Kennedy Jr. has launched a whirlwind of reforms that are reshaping both the nation’s food supply and its vaccine landscape. With sweeping announcements targeting synthetic food dyes and bold moves to overhaul vaccine advisory panels, Kennedy certainly has been busy.

RFK Jr. checks another item off of his to do list. The HHS Secretary has just announced that there is a voluntary agreement with major health insurance companies to reform and streamline the process of prior authorization—a practice where insurance companies require advance approval for certain medical tests, procedures, or medications before they will agree to cover them.

This process has long been criticized for causing delays in care and, at times, outright denials of necessary treatments.

Insurers including UnitedHealth Group’s (UNH.N), UnitedHealthcare, CVS Health’s (CVS.N), oAetna, Cigna Group (CI.N), Humana (HUM.N), Blue Cross Blue Shield Association and Kaiser Permanente met with Kennedy and Centers for Medicare and Medicaid Services Administrator Mehmet Oz, the Department of Health and Human Services said in a statement.

The health insurers pledged six key reforms aimed at cutting red tape, accelerating care decisions, and enhancing transparency for patients and providers, HHS said in the statement.

Participation in the pledge is voluntary, Oz said in a news conference. Three-quarters of U.S. patients are covered by participants in the pledge, he said, adding that CMS will publish the full list of participating plans later this summer.

“There shouldn’t be paper, there shouldn’t be faxes, there shouldn’t be letters being sent. They should all be done digitally and automatically, and 90-day continuity should exist for authorizations when patients switch insurers, so you never fall through the cracks again,” Oz said.

Together, these companies provide coverage for about 257 million Americans, or roughly 80% of those insured through Medicare Advantage, Medicaid Managed Care, the Health Insurance Marketplace, and commercial plans.

Prior authorization is a cost-cutting tool used by health insurers that requires them to sign off on tests, procedures or drugs before patients can get them.

The insurance tactic drew renewed attention last year after the fatal shooting of Brian Thompson, the CEO of UnitedHealth’s insurance arm, in New York City.

Patients and doctors say prior authorization creates too many roadblocks, forcing people to wait days or weeks for needed treatments or denying them altogether.

About 1 in 6 insured adults say they’ve had prior authorization problems, according to a survey from KFF, a health policy research group.

Insurance companies had also promised doctors, hospitals, and Americans the same thing in 2018, under the first Trump administration.

By 2022, the American Medical Association (AMA), which signed onto that agreement, was arguing publicly that insurers failed to live up to their end of the bargain. A 2023 survey by the AMA of 1,000 doctors found 7% of physicians had a prior authorization lead to “a patient’s disability or permanent bodily damage, congenital anomaly or birth defect or death”.

Trump administration officials did acknowledge that the practice could be egregious and warranted change. “A vaginal delivery” often requires prior authorization, said the Trump administration Medicare director Chris Klomp: “Why is that a question mark in this day and age?”

The insurance industry often argues insurers “target its use” to prevent wasteful testing by doctors. However, prior authorization is known to be incredibly widespread: in 2023, a spokesperson for a lobbying group told FierceHealthcare that 93% of beneficiaries were in plans that required prior authorization for nearly a quarter of services.

Let’s hope these reforms are helpful and have staying power.

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Comments


 
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Oracle | June 25, 2025 at 7:12 am

Yes, this has ben a big problem for chronically ill members of my family.


 
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Whitewall | June 25, 2025 at 8:56 am

Hope the promises stick, but I doubt it.


 
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hrhdhd | June 25, 2025 at 10:09 am

My father’s defibrillator’s battery is down to 5%, his doctor scheduled the surgery, and coverage was denied. He had to wait for pre-authorization, and when it came, the window was for a time period that the doctor couldn’t schedule the surgery; that is, it was so short [even included days before the authorization was issued!] that there wasn’t time to get the surgery scheduled before the authorization would run out. Ridiculous.

This sounds like “the check is in the mail.”

Without “a big stick,” the promise is of little value.

The change should be binding on all carriers.

Furthermore, the change should be required for all self-funded health benefits, that are administered by third party administrators.


 
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destroycommunism | June 25, 2025 at 11:01 am

nothing wrong with this action by rfkjr

point out the problems and see how the companies respond

if they are violating a law…take them to court…NOT CONGRESS FOR ANOTHER BUDDY-TO-BUDDY HEARING

but to court


 
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destroycommunism | June 25, 2025 at 11:04 am

dont forget…like sooo many “companies”

THE GOVERNMENT IS ACTUALLY RUNNING THE SHOW

THE COMPANIES ARE THE FRONT so that the politicians dont take the blame but are seen as heros…fixing the problems ( that they created)

this is why soooo many doctors have gone to PRIVATE CONCIERGE practice


 
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BigDaveLA | June 25, 2025 at 6:24 pm

We need President Trump (I love typing that) to sign an EO. If we wait on Congress, we’ll all be dead!

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