Prior authorization requirements cost the U.S. healthcare system an estimated $35 billion each year, and their overuse has ...

Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. Health insurer prior authorization has increased considerably in ...

The health IT arm of the Department of Health and Human Services finalized a rule this week that federal leaders say will remove red tape and enable faster prior authorization and real-time ...

Does Medicare require prior authorization? Medicare Advantage plans often require prior authorization. But these coverage reviews are rare for original Medicare. That distinction changes in 2026. Many ...

Have you ever walked into the pharmacy and been told that your prescription requires a prior authorization? But your healthcare professional prescribed something for you, and you brought in your ...

Many physicians believe prior authorization gets in the way of sound patient care. New reforms from the insurance industry aim to address these challenges. Will they make a difference? You learn a lot ...

Prior authorization has long been a sticking point between payers and providers, with payers arguing that it’s necessary to control costs and ensure that care is medically necessary and providers ...

Prior authorization is a process wherein a doctor must get approval from a patient’s health insurer before providing a medical service, like prescribing a drug or performing a surgery. Payers argue ...

Medicare Advantage plans have increased their use of prior authorization and appear to be targeting certain types of care -- such as expensive post-acute hospital care -- for coverage denials, ...

Nearly all MA enrollees are subject to prior authorization — where providers have to receive an insurers’ approval before offering a service or medication — for some types of care, according to the ...

There is a good reason for health insurers to occasionally require prior authorization for medical treatment. If a doctor prescribes an unusual, experimental, or expensive medication or procedure, the ...