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This analysis of available 2025 prior authorization data finds insurers denied at least 1 in 8 standard requests for prior authorization across three insurance markets: Medicare Advantage, Medicaid managed care, and the federally facilitated ACA Marketplaces. Denial rates varied wide segments by insurer. The analysis highlights limitations of the data and challenges for consumers interpreting it.
In February, the Trump administration launched TrumpRx, a government website that provides prescription drug discounts to consumers. This brief examines issues that may impact consumers, especially those with private insurance, who access drug discounts through TrumpRx.
Amid the growing use of artificial intelligence (AI) in the claims review cycle, this brief discusses the types of consumer protections for use of AI in prior authorization and claims review, describes the Trump administration’s general approach to AI , and highlights areas to watch as Congress considers AI legislation.
Certain insurers must now publicly report specific prior authorization metrics, but the new data offer limited insight, providing no information on what types of services are being approved and denied or why as well as no data on prescription drugs.
