AMA urges CMS to keep prior authorization deadline

The American Medical Association (AMA) is urging the Centers for Medicare & Medicaid Services (CMS) to keep the January 1, 2027, compliance date for electronic prior authorization (ePA). The AMA wants CMS to reject broad enforcement discretion during 2027, as a year of nonenforcement would leave physicians reliant on outdated methods.

AMA CEO John Whyte, M.D., M.P.H., wrote in a letter to Administrator Mehmet Oz, M.D., that the current process consumes an average of 13 hours of physician and staff time each week. A survey of 1,000 practicing physicians found that 95% report prior authorization delays access to necessary care, and 26% report it has led to a serious adverse event for a patient.

Health plans are citing limited physician engagement with ePA to justify a delay, but the AMA argues that this is a manufactured problem. Physicians are not receiving needed education and support from health plan and EHR developer partners, which perpetuates physician “unwillingness” to use ePA. In fact, the survey polled 1,000 practicing physicians in December 2025, highlighting the importance of addressing this issue. Furthermore, health plans are mischaracterizing physician engagement as a lack of interest, when in reality, physicians are not receiving the necessary support, creating a catch-22 over physician uptake.

The AMA is calling on CMS to require EHR developers to provide physician customers with implementation timelines, testing opportunities, training, and technical support. Health plans should also conduct regular outreach to EHR developers and contracted physicians with education and support.

The January 1, 2027, date comes from the CMS Interoperability and Prior Authorization final rule, which requires affected payers to implement a prior authorization API. The rule aims to reduce the administrative burden on physicians and improve patient care. CMS has estimated that the policies will save about $15 billion over 10 years.

As the deadline approaches, reliance grows on third parties to complete the implementation, and those vendors are not subject to CMS oversight and enforcement. The AMA is concerned that a delay would leave physicians without the necessary information and support to successfully implement ePA.

They argue that a delay would have negative consequences for patients and physicians, and that it is essential to stay on track with the compliance date. Since January 2026, affected payers have had to return decisions on medical items and services within 72 hours for expedited requests and seven calendar days for standard ones, demonstrating the progress made so far in improving the prior authorization process.