Commonwealth Fund October 22, 2025
TOPLINES
Prior authorization can help encourage the efficient use of health care resources but too often, it delays treatment patients urgently need. A new framework offers a middle path: applying prior authorization only when evidence shows it’s warranted.
Services in the “green light” category are well-suited to prior authorization and may include treatment with high rates of fraud and low-value care.
Policymakers are increasingly interested in reforming how commercial insurers use prior authorization (i.e., requirements that clinicians seek approval from insurers before providing treatment). Some states have enacted or proposed legislation limiting the use of prior authorization across broad categories of services, such as mental health care and cancer treatment. At the federal level, legislators have introduced measures to regulate...
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