What’s the news: The AMA is highlighting an important win in physicians’ long-running effort to fix prior authorization. The U.S. Department of Health and Human Services (HHS) has agreed with the AMA to minimize care delays and inefficiencies by requiring practices’ technology systems to support an automated process.
The new HHS policies deliver on strong AMA advocacy—last highlighted in a September 2024 comment letter (PDF)—that calls for a streamlined approach that embeds real-time electronic prior authorization into certified EHRs. The policies will standardize how physicians and payers exchange information, paving the way for faster decisions and timelier patient care. The policies require new certification criteria that hardwire electronic prior authorization, real-time prescription benefit checks and modernized e-prescribing into certified EHRs.
“Not to overstate it, but this new policy could contribute to the demise of the fax era in medicine. Prior authorization has tied up staff, delayed coverage and kept fax machines humming far past their prime due to insurance companies’ requirements,” said AMA President Bobby Mukkamala, MD.
The AMA is fighting to fix prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles.
Why it’s important: Due to these changes, physicians will be able to manage prior authorization requests entirely within their EHR systems. That will give doctors the ability—all within their existing workflow—to:
- Check payer coverage requirements.
- Assemble and submit required clinical documentation.
- Initiate prior authorization requests electronically.
- Monitor status.
For prescription medications, the policy integrates enhanced electronic prior authorization capability directly into the updated e-prescribing tools. EHR vendors now will be required to support the same technology mandated for Medicare Part D plans—and already required by many state laws.
The HHS rule also includes a key AMA-supported provision: real-time prescription benefit checks at the point of care. This means physicians can now access patient-specific coverage and out-of-pocket cost information before prescribing—reducing surprises at the pharmacy counter and enabling more informed decisions.
Importantly, these new physician-facing requirements align with the 2024 Interoperability and Prior Authorization Final Rule, ensuring that payers’ systems and EHRs speak the same digital language.
“This is a tangible burden-reduction win for physician practices and a clear path to better outcomes for patients,” said Dr. Mukkamala. “By replacing phones, faxes and portal-hopping with standardized, interoperable EHR connection points, HHS’ new policy turns AMA advocacy into measurable workflow relief and faster decisions. If this is successful, we will continue to push to rightsize prior authorization so it is not a daily impediment to physicians striving to deliver care to their patients.”
The AMA will now collaborate with HHS, EHR developers, standards organizations and health plans to drive timely implementation, ensure strong privacy and security practices, and maintain a focus on what matters most—caring for patients without unnecessary delays.
Learn more: Physicians can explore the technology for electronic prior authorization involving medications further with the AMA’s three-part educational video series on this topic. In addition, this AMA video interview with Viet Nguyen, MD, chief standards implementation officer for HL7 International, details how that organization is working to include physicians in creating technological solutions to the problems caused by prior authorization’s inefficiencies.
Read more from the AMA about the critical changes that must be made to fix prior authorization. Also, visit AMA Advocacy in Action to find out what’s at stake in fixing prior authorization and other advocacy priorities the AMA is actively working on.
