U.S. health insurers UnitedHealth, CVS Health take big steps for prior approval on medicines and medical services. What Americans should know?

UnitedHealth and CVS Health said on Friday they have standardized data and submission requirements for more than half of their prior authorizations, as part of an industry effort to reduce delays and paperwork for patients and doctors. U.S. health insurers, which have ‌come under ⁠scrutiny to simplify ⁠their requirements for prior approval on medicines and medical services, have been working to deliver on commitments made last year to cut red tape and improve transparency.

UnitedHealthcare, UnitedHealth's insurance unit, said more than 70 per cent of prior authorization requests will be part of this standardized process ⁠by the ‌end of the year. The process will apply across its commercial plans, government-backed Medicare Advantage ⁠and Medicaid businesses, the insurer said.

CVS Health said ​its Aetna insurance unit has standardized 88 per cent of ​its prior authorization volume.


The standardized approach will be used for medical services that are commonly subject to prior authorization, such as orthopedic surgeries and imaging services, including CT scans and MRIs, industry group AHIP ‌said.

UnitedHealthcare said it aims to improve predictability, reduce rework and decrease the number of ​requests for ​additional information by standardizing ⁠the information health plans require to support prior authorizations.

It also plans to expand the program to additional medical services ​and continue cutting the number of procedures that require prior approval.

UnitedHealthcare said the changes will not affect coverage rules or the medical reasons used to approve or deny care.