Prior Authorization Reform Is Accelerating—But May Not Impact All Payors

• June 13, 2025

• Robert C. Deegan , Reed Smith LLP

State lawmakers have assumed a leading role in the movement to regulate prior authorization, with many advocating to impose stricter statutes on the payors who utilize such processes. Since January of this year, lawmakers in 29 states have introduced bills that would prohibit, restrict, or otherwise reform payors’ and third-party administrators’ (TPAs’) use of prior authorization (Figure 1). This wave of proposed reform presents significant potential challenges for payors subject to state-level statutes and regulations—a category that could extend beyond traditional insurers offering retail plans to potentially include Medicaid managed care organizations and TPAs overseeing non-insurance health benefit plans.  

ARTICLE TAGS

• Payers, Plans, and Managed Care Practice Group
• Health Insurance