Prior authorizations may be the single least-popular aspect of our healthcare system, generating such consistent criticism from consumers and regulators that the nation’s health insurance companies voluntarily signed a pledge in June 2025 to scale back and streamline their utilization management policies over the next two years. Now just over one year into that pledge, insurers claim to have eliminated 11 percent of prior authorization requirements, but there is a growing sense of skepticism that these internal reform efforts will amount to deceptively little.
 
There’s plenty of accounts from providers and patients about how they are still facing the same prior authorization frustrations, but even more meaningful are the off-the-record conversations we have had with insurers. In 2024 and 2025, US health insurers collectively posted profit margins below one percent, while at the same time promising to roll back prior authorizations, one of their most important tools for limiting medical spending. Now, health plan leaders are privately giving us the sense that they no longer believe they can afford removing that tool from their toolkit, as public opinion must come second to profitability. Health system leaders should assume utilization management, along with payment reform and state affordability initiatives, will continue reshaping reimbursement over the next several years.