Humana Builds Upon Previous Prior Authorization Commitment With Gold Card Program for Physicians, Other Changes

Humana announced today several internal and external improvements they will make to reduce the red tape surrounding prior authorizations, according to a news release. By the end of 2026, they plan to reduce prior authorization requirements, establish a faster process for approvals and create a national gold card program for physicians with a consistent track record.

Two of these changes will be in effect by January 1, 2026. Humana will eliminate approximately one-third of prior authorizations for outpatient services, including diagnostic services such as colonoscopies, select CT scans and MRIs. Humana also pledges to provide a coverage decision within one business day on at least 95% of all complete electronic prior authorization requests. Humana currently provides a decision within one business day on more than 85% of outpatient procedures, according to the news release.

A national gold card program will also be available for physicians in 2026. This card will waive certain prior authorization requirements for physicians with a proven record of high-quality care and who submit coverage requests in a timely manner.

In 2026, Humana will also publicly report its prior authorization metrics, which will include data on approved and denied requests, as well as requests approved after appeal and the average time between submission and decision.

“Today’s healthcare system is too complex, frustrating, and difficult to navigate, and we must do better,” Jim Rechtin, president and CEO of Humana, said in the news release. “We are committed to reducing prior authorization requirements and making this process faster and more seamless to better support patients, caregivers, physicians and healthcare organizations.”

Humana is currently working to improve interoperability and decrease administrative burdens by improving physicians’ electronic healthcare workflows to reduce turnaround times and by accepting more prior authorization requests electronically. Industry-wide, nearly half of prior authorization requests for prescription drugs (47%) and medical services (45%) are done manually by physicians, according to a survey from America's Health Insurance Plans (AHIP).

Today’s announcement builds upon last month’s commitment, where more than 50 health insurance companies, including Humana, pledged to streamline the prior authorization processes using six new commitments:

• standardize electronic prior authorization, implementing common and transparent submissions by Jan. 1, 2027;
• reduce the scope of claims subject to prior authorization by Jan. 1, 2026;
• ensure continuity of care when patients change plans beginning Jan. 1, 2026;
• enhance communication and transparency of determinations by Jan. 1, 2026;
• expand real-time response for at least 80% of electronic prior authorization approval in 2027; and
• ensure medical review of non-approved requests.

“These measurable commitments—addressing improvements like timeliness, scope and streamlining—mark a meaningful step forward in our work together to create a better system of health,” Kim Keck, president and CEO, Blue Cross Blue Shield Association, said in last month’s news release.

These changes are expected to benefit approximately 257 million Americans across insurance markets, including those with commercial coverage, Medicare Advantage or Medicaid.

Approximately 25% of healthcare spending is considered unnecessary, thanks to overtreatment, outdated technology and fraud, according to a JAMA Network article. A Pew Research Survey shows that the cost of healthcare is among the top three biggest concerns for Americans, with 89% expressing concern.