We know how critical timely access to care is—especially for those living with rare and chronic diseases like APS Type 1. That’s why we’re encouraged by a new commitment made this week by many major health insurance companies to reduce unnecessary delays in care caused by prior authorization (PA) processes.
A New Commitment to Change
On Monday, a group of health plans representing approximately 75% of insured individuals in the United States signed a voluntary pledge to streamline and simplify prior authorization over the next several years. This step was announced in coordination with the Centers for Medicare & Medicaid Services (CMS), which stated it will hold plans accountable and may take regulatory action if the promised reforms are not implemented.
What the Pledge Includes
The insurance companies that signed the pledge have committed to six key reforms aimed at improving patient care and reducing administrative barriers:
- Standardizing Electronic Prior Authorization (ePA)
By January 2027, plans aim to implement a standardized electronic system across all types of insurance coverage to help speed up the PA process. - Reducing In-Network Medical PA Requirements
By January 2026, insurers will decrease the number of services that require prior authorization within in-network care, specifically for fully insured, Affordable Care Act (ACA), and Medicare Advantage plans. - Ensuring Continuity of Care When Switching Plans
Starting in January 2026, patients who change health plans will be able to carry over prior authorizations for the same drug or service for a 90-day transition period—helping to prevent care disruptions. This commitment spans all coverage types. - Improving Communication and Transparency
By January 2026, plans will be required to clearly communicate PA decisions, explain next steps, and share appeals processes. This applies to commercial, ACA, and Medicare Advantage coverage. - Expanding Near Real-Time PA Decisions
By 2027, insurers pledge that 80% of electronic PA requests with complete documentation will receive near real-time responses, which could significantly shorten wait times. This goal applies to all insurance types. - Clinician Review of Denials
All denied requests will continue to be reviewed by qualified clinicians to ensure that medical expertise informs final decisions, across all types of coverage.
What This Means for the APS Type 1 Community
Prior authorization can be a significant hurdle for those with rare diseases, often delaying access to vital medications and specialized treatments. This pledge—if fully implemented—could reduce the burden on patients, caregivers, and healthcare providers alike.
We are encouraged by these voluntary commitments and CMS’s intent to ensure follow-through. Additionally, leaders in Congress have signaled bipartisan interest in supporting these reforms through legislation if needed.
Looking Ahead
We will continue to monitor the rollout of these changes and advocate for the needs of our community every step of the way. At the APS Type 1 Foundation, we believe that no one should have to wait for critical care because of red tape. This announcement is a step in the right direction—and we’ll keep working to make sure that promise turns into reality.