Prior Authorization Modernization Enters Its Next Phase

More than 35 million seniors and people with disabilities enrolled in Medicare Advantage rely on a system that delivers care quickly, coordinates effectively across providers, and uses technology to support — not complicate — the doctor-patient relationship. Modernizing prior authorization is central to that promise. 

That’s why Better Medicare Alliance welcomes CMS’s announcement expanding the Health Tech Ecosystem to include electronic prior authorization. Building on the landmark health plan pledge announced earlier this year to simplify prior authorization, which BMA was proud to support, this next step brings hospitals, physician practices, electronic health record vendors, and digital health developers to the table alongside payers. Modernizing prior authorization is a system-wide challenge, and it requires a system-wide solution. 

Prior authorization plays an essential role in coordinating high-value care and ensuring beneficiaries receive treatments supported by the best available clinical evidence. It also helps contain costs — a benefit that flows to both patients and taxpayers. When the process works as it should, beneficiaries get frictionless access to the care they need, and the system as a whole is more efficient and accountable. 

There is meaningful progress being made around improving prior authorization for patients and providers. Today, 95% of prior authorization requests in Medicare Advantage are approved on the first try. But some friction remains, much of it driven by outdated technology on the provider side. The American Medical Association reports that 45% of all prior authorization requests are still submitted by fax. Wider adoption of electronic prior authorization — supported by every part of the health care ecosystem — will make the process faster, easier, and more accurate.  

Leading health plans have voluntarily eliminated millions of prior authorizations across a range of services, and standardized electronic processes are scaling rapidly. The CMS Interoperability and Prior Authorization Final Rule deadlines now in effect — including faster decision timelines for Medicare Advantage and all payers — represent important steps forward, and the launch of electronic prior authorization interfaces in January 2027 will accelerate that progress further.  

BMA has long supported efforts to streamline prior authorization in Medicare Advantage in ways that protect beneficiaries, reduce provider burden, and preserve the care coordination that makes MA work for seniors. 

Medicare Advantage beneficiaries — and the providers who care for them — benefit when the system works better together. BMA will continue to champion the policies, partnerships, and innovations that deliver on that promise.