US States Pass New Laws to Curb Health Insurance Prior Authorization

More than 30 states have passed laws intended to limit the use of prior authorization by health insurance companies, according to reporting from NPR on March 13, 2026. These legislative efforts aim to prevent insurers from second guessing doctors when determining the necessary care for patients.

Prior authorization serves as a utilization management tool that health insurers use to decide if a specific treatment or service is medically necessary before We see provided to the patient. While some proponents argue the process is an essential measure for cost containment, critics contend that it creates significant burdens for healthcare providers and leads to dangerous delays in patient care.

Legislative Reform Strategies

States are utilizing several different legislative strategies to reform how prior authorization is applied. One prominent approach is the implementation of gold card programs, which allow healthcare providers with high approval rates for their requests to bypass prior authorization requirements entirely.

According to data from MultiState published on August 14, 2025, Arkansas, Texas, and West Virginia have amended their laws regarding these gold card programs as part of a broader momentum toward reform.

Other reform measures include the removal of prior authorization requirements for specific classes of drugs and the establishment of mandatory decision timeframes. These timeframes are designed to ensure that insurers provide responses to both urgent and non-urgent requests within a set period to avoid prolonged care delays.

Continuity of Care and Chronic Disease Management

Some states are focusing on the transition between insurance plans to ensure patients do not lose access to critical treatments. A measure passed in Vermont requires a new health insurer to accept the prior authorizations of a patient’s previous health plan for up to 90 days.

Similar efforts have been seen in Massachusetts, where the legislature considered a bill that would require new insurers to honor prescription drug prior authorizations from a previous plan for at least 90 days after enrollment. That proposal suggested that authorizations for treatments related to chronic disease management should remain valid for the length of the prescription, up to 12 months.

Timeline of State Action

The push to rein in insurance company requirements has accelerated over the last few years. In 2023, the District of Columbia and nine states passed prior authorization reform laws.

By August 19, 2024, the American Medical Association reported that 10 additional states had passed legislation addressing the issue. These states included:

• Vermont
• Minnesota
• Wyoming
• Colorado
• Illinois
• Mississippi
• Maine
• Maryland
• Oklahoma
• Virginia

These 2024 laws generally focused on reducing the volume of prior authorization requirements, improving transparency regarding which procedures require authorization, and increasing the amount of data that insurers must report publicly.

Impact and Urgency

The drive for these legal changes is often linked to the real-world consequences of insurance denials. In West Virginia, the push to tackle prior authorization gained urgency following the death of a man who had experienced insurance denials.

Medical societies and the American Medical Association have advocated for these changes to reduce the wasted time and care delays experienced by both physicians and patients when authorization requirements are applied excessively.