At Premera Blue Cross, we believe that health care should be safe, effective, and affordable—and that starts with making sure our members get the right care, in the right place, at the right time. That’s why we’re proud to join Blue Cross and Blue Shield (BCBS) companies across the country in announcing a series of improvements to the prior authorization process.
Prior authorization is a vital tool that helps ensure treatments and services are medically necessary, evidence-based, and not duplicative. It’s one of the ways we help lower out-of-pocket costs for our members and keep premiums more affordable for everyone. But we also recognize that the process hasn’t always been as smooth or transparent as it should be. That’s changing.
Here’s how we’re making prior authorization better for our members and providers:
1. Reducing Prior Authorizations
We’re building on years of work to reduce the number of services that require prior authorization. By January 1, 2026, BCBS companies, including Premera, will demonstrate meaningful reductions in in-network prior authorization requirements, tailored to the needs of each local market.
2. Faster, Real-Time Decisions
By 2027, we’re committing to provide near real-time responses for at least 80% of electronic prior authorization requests—so long as all necessary clinical documentation is included. That means less waiting and more certainty for patients and providers.
3. Clearer Communication and Personalized Support
We’re enhancing transparency by making sure our messages about prior authorization are clear, personalized, and actionable. Members will receive information about what’s needed for approval, next steps, and how to appeal if necessary. Trained support staff will be available to answer questions and guide members through the process.
4. Continuity of Care When Switching Plans
Starting January 1, 2026, if a member switches health insurance plans, even to or from a non-BCBS plan, Premera and other participating BCBS companies will honor the previous plan’s prior authorization for 90 days, as long as the service is a covered benefit and provided in-network.
5. Clinician-Led Reviews
All prior authorization requests that can’t be automatically approved will continue to be reviewed by licensed, qualified clinicians. These decisions are guided by national best practices to ensure safe, effective care.
6. Less Paperwork, More Patient Time
We’re working toward a standardized, transparent system for submitting electronic prior authorization requests. This will reduce administrative burden and free up more time for providers to focus on patient care. Our goal is to have this system in place by January 1, 2027
These changes are part of a broader, voluntary commitment by BCBS companies to improve the healthcare experience for everyone. At Premera, we’re proud to lead the way in creating a more efficient, affordable, and sustainable system, and one that puts members.
