Prior authorization is when your plan must approve a service or drug before it will pay. It’s used to control cost and confirm medical necessity, but it can delay care. In 2025–2026 the rules are tightening: CMS added Medicare Advantage guardrails, about 60 insurers pledged to cut it, and Texas limits AI-only denials and “gold cards” reliable providers out of it.
Prior Authorization
Prior authorization requires the plan’s approval before certain care or drugs are covered. These FAQs explain how it works and the recent reforms.