April 22, 2026
Prior authorization can be the exception, not the rule
Aligning care and coverage can reduce friction, improve access, and preserve appropriate clinical oversight.
Prior authorization plays an important role in today’s health care system. At its best, it helps ensure care is safe, appropriate, and grounded in clinical evidence.
But for many patients and clinicians, that is not the experience. Instead, prior authorization — or preapproval of specific services or medications by the health plan — can mean delays, uncertainty, and administrative burden. Patients are left waiting for answers. Clinicians spend valuable time navigating processes instead of caring for people.
These challenges have made prior authorization a growing focus for policymakers, and a clear opportunity for improvement.
Kaiser Permanente’s experience points to a better path forward. It shows that it’s possible to reduce prior authorization where it adds little value, simplify the process where it remains necessary, and preserve its role in supporting safe, appropriate, evidence-based care.
Our value-based care model reduces the need for prior authorization
For more than 80 years, Kaiser Permanente has worked to deliver high-quality, affordable health care and improve the health of our members and the communities we serve.
Today, about 93% of our members’ ambulatory care happens within Kaiser Permanente, where we rarely need prior authorization.
We provide services to over 12.6 million members and patients, and our more than 240,000 employees and 25,000 physicians are focused on delivering better health outcomes at lower cost while investing deeply in our communities.
Kaiser Permanente is different from other coverage providers. We combine high-quality health care and coverage into one coordinated experience.
Our aligned approach enables us to deliver evidence-based care faster — and helps members avoid unnecessary visits and serious health conditions.
Most of the time, our members get care in Kaiser Permanente facilities from Kaiser Permanente clinicians.
Today, about 93% of our members’ ambulatory care happens within Kaiser Permanente, where we rarely need prior authorization.
This approach works because our clinicians use evidence-based guidelines when making care decisions. Doctors develop these guidelines, and we embed them into our clinical workflows.
The guidelines support consistent, high-quality care while still allowing room for professional judgment. That is a core part of our value-based care model, and one reason traditional prior authorization is needed less often.
In 2024, Kaiser Permanente averaged about one-third as many prior authorization requests per Medicare Advantage enrollee as the industry overall.
The impact is measurable. In 2024, Kaiser Permanente averaged about one-third as many prior authorization requests per Medicare Advantage enrollee as the industry overall.
When prior authorization still applies
Even with our integrated approach, prior authorization still plays a role in certain situations.
- External referrals (HMO plans): When a clinician recommends a member get care outside of Kaiser Permanente, we review the referral. In 2024, we processed more than 2 million of these referrals and approved about 98%.
- Certain services (non-HMO plans): When members choose to receive care outside of Kaiser Permanente, some services may require prior authorization. Our clinicians review these requests based on medical need. They use the same evidence-based guidelines that guide care within Kaiser Permanente.
Leading improvements in health care
In 2024, we processed more than 2 million of these referrals and approved about 98%.
Kaiser Permanente relies on prior authorization far less than many other health plans. Even so, we continue to make changes to reduce burden and improve the experience for patients and clinicians.
We’re guided by a commitment to streamline, simplify, and reduce prior authorization. Recent improvements include:
- Reducing requirements: We’ve removed more than 3,600 services from prior authorization lists across our non-HMO plans. We expect these changes to reduce the need for prior authorization by nearly 20% in 2026.
- Avoiding interruptions in care: We now honor prior authorizations from a member’s previous health plan for at least 90 days. This helps patients continue treatment without disruption when they change coverage.
- Improving communication: We’ve simplified denial letters, clarified next steps, and enhanced staff training. This way, members and clinicians can more easily understand what’s needed and why.
Policymakers can help improve prior authorization
Kaiser Permanente’s model offers important insights for policymakers and the broader health care industry.
Our experience shows that prior authorization doesn’t have to be used as often as it is today. And when prior authorization is needed, it can be faster, clearer, and guided by clinicians.
Effective reform should not focus solely on refining prior authorization processes — it should also aim to reduce reliance on them. That means looking beyond administrative fixes alone and supporting a shift to a more value-based health care system.
Policymakers can support this shift by:
- Encouraging value-based care models that align incentives and embed evidence-based decision-making at the point of care
- Supporting technology that makes prior authorization simpler when it’s still needed
- Preserving flexibility and avoiding overly rigid or duplicative regulatory requirements
There’s no single solution to the challenges associated with prior authorization. But progress is possible — and happening.
When health plans, clinicians, and policymakers work together, they can reduce burden, improve care access, and rebuild trust.
