Rule changes force a long-hidden process into the open
Federal regulators have required Medicare Advantage, Medicaid and marketplace plans to publish annual prior authorization statistics, producing the first public scorecards that show how often plans approve, deny and delay care. Plans were required to post aggregated metrics for the previous calendar year by March 31, 2026, and the disclosures must include approval and denial rates, appeal outcomes, and average decision times.
What the disclosures show
The initial round of reports covers calendar year 2025 and reveals striking variation across insurers. Industry compilations and independent trackers show that some large plans issued only about 1 prior authorization request per enrollee while others required 3 or more. Denial rates also vary widely, with some parent organizations reporting denial rates in the low single digits and others reporting denial rates above 10 percent.
Scale and consequences
The new transparency comes against a backdrop of very large volumes of reviews. Recent analyses put prior authorization determinations in Medicare Advantage in the tens of millions annually, with roughly 52.8 million determinations in 2024 and about 4.1 million full or partial denials that year. Those numbers help explain why clinicians and patient advocates have pushed for clearer metrics: prior authorization processes can slow care and, in some cases, lead clinicians to change or abandon recommended treatments.
Early results and limits
Experts caution that the first public reports are imperfect. The rule requires aggregated, program level disclosures but does not force plans to break data down by service type or denial reason. That makes it hard to tell whether higher denial rates reflect tougher medical review, different benefit design, or simply different coding and reporting practices. Analysts say the raw numbers are useful, but incomplete.
What comes next
Regulators and consumer groups say the new transparency is a first step toward accountability. Payers must also speed decisions: standard requests are to be resolved within seven calendar days and expedited requests within 72 hours under the same rule. Policymakers will now watch whether public scorecards spur plans to reduce unnecessary prior authorizations and shorten delays that patients and providers say have become routine.