On June 23, 2025, health plans convened by AHIP and the Blue Cross Blue Shield Association announced six voluntary commitments to “streamline, simplify and reduce prior authorization.” The signature block lists 48 entries — some covering multiple affiliated plans, a group the American Medical Association rounds to roughly 60 insurers — and the plans said the changes would reach 257 million Americans. The deadlines are staggered: one commitment was declared in effect at announcement, three came due on January 1, 2026, and two come due in 2027.1
This page is a tracker, not a news story. It sets each commitment against two records: what the insurers and their trade associations have publicly documented about delivery, and what practicing physicians report in the AMA's annual prior-authorization survey. It is a living document — we revise it at each pledge milestone and each new public disclosure, and the dated changelog at the bottom records every revision.
The case for tracking is in the record itself. In January 2018, national associations for insurers and providers signed a consensus statement whose provisions parallel much of the 2025 pledge. Eight years later, the AMA's survey data reported little delivered progress against it: 84% of physicians say prior authorizations for prescription medications increased over the past five years, and 82% say the same for medical services.4 The 2025 pledge is the second industry-wide commitment of its kind. This page records whether the second one is met.
33%4
of surveyed physicians believe the pledge will make a meaningful difference
24%4
report denials are reviewed by a licensed and qualified clinician — the one commitment already in effect
11%2
reduction in prior authorizations the trade groups report under the pledge, as of April 2026
The tracker: six commitments, two records
Deadline language below is taken from the pledge text. The evidence column holds only what has been published — chiefly the trade associations' April 2026 progress disclosure, a survey of the participating plans themselves. The physician column comes from the AMA survey, fielded in December 2025: weeks before the January 2026 milestones came due, so it reads as the baseline those milestones will be judged against — and as a direct measure of the one commitment that was already in effect.
| Commitment | Deadline | Public evidence of delivery | What physicians report |
|---|---|---|---|
| Medical review of non-approved requests — denials based on clinical reasons reviewed by medical professionals | In effect at announcement (June 2025) | Affirmed by the plans as “a standard already in place”; no delivery metric published | 24% agree denials are reviewed by a licensed and qualified clinician; 16% of peer-to-peer participants say the plan’s “peer” is often or always qualified |
| Reduce the scope of claims subject to prior authorization, per local market | Demonstrated reductions by Jan 1, 2026 | Trade groups’ April 2026 survey of participating plans: 11% reduction across covered markets (6.5 million fewer PAs); more than 15% in Medicare Advantage — self-reported | 84% say prescription-medication PAs rose over five years; 82% say the same for medical services; physicians average 40 PAs per week |
| Honor existing prior authorizations for 90 days when a patient changes plans (benefit-equivalent, in-network) | Beginning Jan 1, 2026 | April 2026 update: “many plans have established secure data-sharing processes” and added customer-service support; no count or rate published | 61% say prior authorization at least sometimes destabilizes a patient who was stable on a treatment plan |
| Clear, easy-to-understand explanations of determinations, with appeal support | Fully insured and commercial coverage by Jan 1, 2026 | April 2026 update reports enhanced notices and appeals information — descriptive only, no metric | Not separately scored in the survey; overall, 33% expect the pledge to make a meaningful difference |
| Standardized electronic prior authorization (FHIR APIs), common data and submission requirements | Goal: operational by Jan 1, 2027 | Not yet due. Trade groups describe the 2027 items as “a substantial technical and operational undertaking” | 24% report their EHR offers electronic PA for prescriptions; phone remains the most common channel for medical-service PAs |
| At least 80% of electronic PA approvals (with complete clinical documentation) answered in real time | In 2027 | Not yet due; the 80% goal was reaffirmed by BCBSA in April 2026 | 95% say prior authorization delays access to necessary care — the baseline the 2027 milestones will be measured against |
Commitment and deadline language from the pledge text (source 1). Delivery column: the trade associations’ own progress disclosures (sources 2–3), self-reported and not independently audited. Physician column: AMA survey of 1,000 physicians, fielded December 2025 (source 4).
What physicians report
The AMA fielded its 44-question survey in December 2025 — six months after the pledge, weeks before its first major deadline — with 1,000 practicing physicians: 400 in primary care, 600 specialists. It published the findings in May 2026.4On the pledge itself, one in three respondents (33%) believe the commitments will make a meaningful difference for patients and physicians. On the single commitment that was in force while the survey ran — clinician review of denials — 24% agree it is happening as promised, and among physicians who participate in peer-to-peer reviews, 16% say the health plan's “peer” often or always has the appropriate qualifications.4
The rest of the survey describes the workload the pledge is meant to shrink: an average of 40 prior authorizations per physician per week, consuming 13 hours of physician and staff time; 26% of physicians report that prior authorization has led to a serious adverse event for a patient in their care, including hospitalization, permanent impairment, or death; 94% say it contributes to burnout.4
Source 4: 2025 AMA Prior Authorization Physician Survey — 1,000 physicians (400 primary care, 600 specialists), fielded December 2025, before the pledge's first major deadline.
“When only a third of physicians expect meaningful impact — and so few report that health plan reviewers are appropriately qualified — it highlights a credibility gap that won't be closed with vague or partial measures.”5
Bobby Mukkamala, M.D., AMA president — AMA press release, May 13, 2026
What comes due next
The 2027 commitments are the most measurable in the pledge: a standardized FHIR-based submission framework “operational and available to plans and providers by January 1, 2027,” and — in the pledge's own words — “in 2027, at least 80 percent of electronic prior authorization approvals (with all needed clinical documentation) will be answered in real-time.”1 A percentage with a date is a testable claim, and this page will test it when the disclosures arrive.
Two gaps in the record are worth naming now. The April 2026 progress disclosure reports one aggregate figure for the reduction commitment — no plan-by-plan numbers, and no stated target the 11% can be read against, since the pledge left each plan's reduction to “the local market each plan serves.”2 And the commitments differ by line of business: the communication commitment, for example, is scoped to fully insured and commercial coverage.1 We will update this tracker at the January 2027 milestone, or at the next public disclosure from the signatories, the AMA, or regulators — whichever comes first.
Tracker updated July 2026 — first edition: pledge terms (Jun 2025), insurer progress disclosure (Apr 2026), AMA physician survey (fielded Dec 2025, published May 2026). Next scheduled review: the January 1, 2027 milestones, or the next public disclosure, whichever comes first.
Sources
- 1AHIP — Health Plans Take Action to Simplify Prior Authorization (pledge text, deadlines, signatory list) · Jun 23, 2025
- 2AHIP — Health Plans Reduce Prior Authorization, Support Continuity of Care and Enhanced Consumer Communications (progress update: 11% reduction, 6.5M fewer PAs) · Apr 7, 2026
- 3Healthcare Dive — Insurers committed to cutting prior authorizations have eliminated 11% so far · Apr 7, 2026
- 4AMA — 2025 Prior Authorization Physician Survey (44 questions, 1,000 physicians, fielded December 2025) · published May 2026
- 5AMA — AMA Survey: Prior Authorization Reform Pledge Falls Short with Physicians (press release) · May 13, 2026