Bobby Mukkamala, MD

President, American Medical Association

Thanks to the persistent and highly effective advocacy work of the Colorado Medical Society (CMS), its partner specialty societies, and a CMS-led coalition of patient stakeholders, Colorado has enacted a prior authorization reform law that takes effect Jan. 1, 2026 that will rein in health plans’ use of this onerous cost-control measure that endangers patients, wastes resources and undermines the expertise of physicians.

The AMA was thrilled to support CMS in this three-year effort. Among the many impactful reforms in the new law, prior authorization approvals will be extended from 180 days to a full year (or the length of treatment), so patients’ continuity of care is protected, and physicians’ time is not wasted on repeat prior authorizations. There will be enhanced transparency of prior authorization requirements and improved prior authorization data reporting to allow for greater plan accountability. 

Also, Colorado lawmakers aligned prior authorization automation efforts with those taking place at the federal level, to better streamline the process within the physician’s electronic health record (EHR) and not through the use of multiple portals and logins. And physicians will be able to count on prior authorization approvals for payment, without the fear of retroactive denials.

Achieving meaningful prior authorization reform in the Rocky Mountain State – and ensuring that more health care decision-making takes place between patients and physicians – was due in large part to the Health Can’t Wait Colorado campaign coordinated by CMS. This effort to collect firsthand prior authorization experiences from patients and physicians helped convince state lawmakers that real reform was needed now. 

Right-sizing is an AMA priority

As the physician’s powerful ally in patient care, the AMA has been working closely with CMS and our other partners in the Federation of Medicine to streamline and simplify a process that has morphed from a rarely used tool intended to limit the use of expensive, newly introduced medications or treatments into a utilization management strategy that payers regularly invoke before patients can receive even the simplest generic medications or time-proven, evidence-based treatments.

Prior authorization hassles remain a source of endless frustration for me, my small staff and our patients in Flint, Mich. Hassles may be too mild a term. Just a few months ago, a member of my staff had to call an insurer over a prior authorization issue because “Mukkamala” wasn’t coming up as a provider in their system. Even though I have been practicing for a quarter-century, my name failed to appear on physician roster compiled by the largest insurer in my home state of Michigan. 

This is an isolated example, to be sure, but also a symptom of an unsustainable process that must be changed. To fully gauge the depth of this problem and the reforms we need, you can see other physicians share some of their very worst experiences with prior authorization here.

New technology will help

Electronic prior authorization (ePA) is on the horizon. New policies from the Centers for Medicare and Medicaid Services require health plans to accept, track and return PA decisions electronically, which will cut wait times and paperwork. Colorado physicians are lucky to have a state medical society leading the way in connecting state automation requirements with these new federal rules through state law, to ensure the most streamlined and least burdensome transition. 

The AMA is ensuring the physician voice is front and center in ePA development. The goal is for EHR systems to fire off requests and receive instant responses, turning today’s fax-and-phone marathon into a seamless “electronic handshake.”

For medical practices, that future starts with a question: When will my EHR be ePA-ready? Ask your vendor for the upgrade timeline, pilot opportunities, and any training or interface costs. Early engagement lets you shape workflows, prepare staff, and position your practice to reap the efficiencies — and faster patient care — once payers flip the switch in 2027.

The AMA will continue to carefully monitor the implementation of the prior authorization reforms that health plans have pledged to implement nationwide, gauge their impact, and do everything in our power to see that good intentions become concrete reality. Insurers can and should do much more to improve patient care than giving lip service to prior authorization reform. It’s time to follow Colorado’s example and make prior authorization reform a reality nationwide.

Hear more from Dr. Mukkamala at the CMS Annual Meeting in Keystone. He will present a session on Saturday, Sept. 20. Register for the meeting on our website, www.cms.org.