Andrew Mellin, M.D., discusses Surescripts’ pilot program for prior authorization system, which pulls clinical data from EHRs ...

The Centers for Medicare & Medicaid Services has proposed a 2026 rule to modernize and speed up prior authorization for drugs ...

Athenahealth and CoverMyMeds joined forces to streamline how patients receive prescriptions that require prior authorization from payers. Athenahealth integrated CoverMyMed’s electronic prior ...

Prior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.

Prior authorization has become one of the clearest points where administrative complexity directly affects patient care. For ...

RadNet is a national radiology provider with 344 imaging centers employing 8,000 people and 500 radiologists. It has regional networks in New Jersey, New York, Delaware, Maryland, California and ...

The relationship between payers and providers has been historically contentious, with prior authorization being one of the biggest pain points. The process remains a heavily manual and costly burden ...

Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. Health insurer prior authorization has increased considerably in ...

Prior authorization requirements cost the U.S. healthcare system an estimated $35 billion each year, and their overuse has triggered a backlash, stirring some policymakers into action. Whether these ...

The Centers for Medicare & Medicaid Services (CMS) has proposed extending its electronic prior authorization requirements to include prescription drugs, aiming to speed decisions and improve ...

Prior authorization is the process by which your doctor must request approval from your Medicare plan before they can order a particular medication or medical service. Generally, Original Medicare ...

Does Medicare require prior authorization? Medicare Advantage plans often require prior authorization. But these coverage reviews are rare for original Medicare. That distinction changes in 2026. Many ...