Health insurers last year pledged to streamline, simplify and reduce prior authorization requirements, but a new AMA survey shows that only one in three physicians believes that meaningful change for patients and doctors will come to fruition.
After successful engagement from the Trump administration to address widespread concerns from patients and physicians, more than 60 health insurers last summer voluntarily made six key commitments to, over the next two years, make improvements to a broken and burdensome prior authorization system that delays patient care. Among the carriers taking the pledge were UnitedHealthcare, Aetna, Cigna, Humana, Elevance Health and the Blue Cross Blue Shield Association plans.
And that 2025 pledge came years after a 2018 consensus statement promising to improve prior authorization. That statement outlined five key areas for meaningful action, including selective use of the process and protections for continuity of patient care.
Yet, data from the AMA’s 2025 prior authorization survey shows that few physicians are seeing changes in the areas insurers have repeatedly agreed to change.
For example, despite insurers promising that beginning in June 2025 that they would ensure medical review of nonapproved requests, only 24% of physicians said they agreed that health-plan denials based on medical necessity for clinical factors are being reviewed by a licensed and qualified physician.
Further, just 16% of physicians participating in peer-to-peer reviews reported that the health plan’s “peer” often or always has the appropriate qualifications.
“Physician trust in voluntary insurer pledges is deeply eroded after years of unfulfilled promises,” said AMA President Bobby Mukkamala, MD. “When only a third of physicians expect meaningful impact— and few see existing commitments fully implemented—it highlights a clear credibility gap that won’t be closed with vague or partial measures.”
He said insurers will have to rebuild trust with patients and physicians by taking sustained, transparent and measurable action that streamlines prior authorization and makes the practice clinically-focused and patient-centered.
“Anything less risks reinforcing the skepticism these pledges were meant to address,” said Dr. Mukkamala, who last year wrote about the importance of insurer executives’ concrete actions to fulfill the promises that they made.
Physicians’ skepticism is similar to the doubt that patients have expressed about prior authorization reforms. A July 2025 KFF poll showed that among patients surveyed, only 39% believed that insurers will follow through on making changes that will make a difference for them.
The AMA is fighting to fix prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles.
Are prior auth promises being met?
Deadlines for changes that insurers pledged to in 2025 are staggered, with health plans agreeing to make a set of changes by Jan. 1, 2026, including reducing the scope of medical services subject to prior authorization. They agreed to make other changes by Jan. 1, 2027, including standardizing electronic prior authorization.
As part of the 2025 AMA survey, 1,000 practicing physicians were asked about progress that’s been made toward commitments insurers made in the 2018 “Consensus Statement on Improving the Prior Authorization Process” (PDF). Here are the commitments and what the numbers from the survey showed.
Selective application of prior authorization based on physician performance: Just 5% of physicians reported contracting with health plans offering programs that exempt providers through programs such as gold card programs.
Prior authorization program review and adjustment based on low variation in utilization or low prior authorization denial rates: 84% of physicians reported that the number of prior authorizations required for prescription medications rose over the past five years, while 82% say that is true of medical services.
Transparency and effective communication regarding prior authorization between payers and providers: 63% of physicians said it is difficult to determine whether a prescription medication requires prior authorization, and 62% say that is true of medical services. Meanwhile, 27% of physicians reported that drug prior authorization requirement information in their EHR or electronic prescribing system is rarely or never accurate.
Continuity of patient care protections to limit the negative impact of prior authorization on stabilized patients: 88% of physicians said that prior authorization interferes with continuity of care; 61% reported that it at least sometimes destabilizes a patient whose condition was previously stabilized on a specific treatment plan.
Enhanced prior authorization process automation to improve transparency and efficiency: only 24% of physicians report that their electronic health record system offers electronic prior authorization for prescription medications. Physicians report that the phone is the most commonly used method for completing prior authorizations for medical services.
Patient harm, physician burden
Similar to previous findings, physicians most recently surveyed are concerned about how prior authorization delays interfere negatively with their patient’s health, and they continue to report that prior authorization strains them mentally and financially.
Below are some key findings from the 2025 survey. Among physicians:
- 26% reported that prior authorization has led to a serious adverse event for a patient in their care, including hospitalization, permanent impairment or death.
- 95% said prior authorization delays access to necessary care.
- 79% reported that patients abandon treatment due to authorization challenges.
- 92% said prior authorization negatively affects clinical outcomes.
The data also shows the strain that prior authorization puts on physicians and their staff:
- Physicians on average complete 40 prior authorizations per week, with this weekly workload consuming an average of 13 hours of physician and staff time.94% reported that prior authorization contributes to burn out.
- 40% of physicians employ staff dedicated solely to prior authorization tasks.
- 32% reported prior authorization requests are often or always denied.
- 74% reported that denials have increased over the past five years, and six in 10 express concern that augmented intelligence (AI) may further increase denial rates.
Meanwhile, physicians reported that prior authorization creates inefficiencies and unnecessary costs across the health system as a whole, too. For example, 88% of physicians reported that prior authorization increases overall healthcare utilization, contributing to waste rather than savings.
- 75% said prior authorization leads to ineffective initial treatments.
- 73% said there are additional office visits.
- 47% said it results in urgent or emergency care.
- 32% said it results in hospitalizations.
Visit FixPriorAuth.org to see how patients, physicians and health professionals around the country are negatively affected by prior authorization burdens and to share your story.
