Cigna Removes Prior Authorization for 25% of Medical Services

Cigna Healthcare is removing prior authorization requirements for nearly 25 percent of medical services, facilitating access to care for members.

The Cigna Group’s health benefits provider announced that an additional 600 codes will no longer require prior authorization or precertification. With these additions, Cigna has eliminated the utilization management process for over 1,100 services since 2020.

Prior authorization aims to prevent overutilization of unnecessary medical services and increase adherence to evidence-based standards of care. However, the requirements have been known to exacerbate administrative burden for providers and result in patient care delays.

“Our goal is to help keep patients safe, improve health outcomes, and make care more affordable, and this important step will enable us to do that while removing administrative burdens on the healthcare system,” David Brailer, MD, executive vice president and chief health officer of The Cigna Group, said in the press release.

“We’ve listened attentively to our clinician partners and are deliberately making these changes as a result. We will continue to hold ourselves accountable for this important work and look forward to building on this momentum in the future.”

Less than four percent of medical services for Cigna members will require prior authorization. The payer said it will streamline the use of the process to improve care delivery. Additionally, Cigna will remove prior authorization for almost 500 additional codes in Medicare Advantage plans this year.

“Prior authorizations are an important step to ensure patient safety and affordability, but clinicians and health plans alike agree that more can be done to reduce the administrative burden on clinicians,” said Scott Josephs, MD, chief medical officer of Cigna Healthcare. “We will continue to engage with clinicians to align on care delivery goals and outcomes and evaluate whether there are other changes we can make without compromising patient safety. We will also drive continued success with value-based care.”

As provider organizations call for more streamlined prior authorization processes, Cigna is not the only health plan that has responded by reducing requirements.

UnitedHealthcare announced plans to eliminate almost 20 percent of prior authorization requirements this year. The payer also said it will implement a national Gold Card program for eligible provider groups in 2024, allowing them to follow an administrative notification process for most procedure codes instead of the prior authorization process.

Humana removed its prior authorization for cataract surgery for Medicare Advantage beneficiaries in Georgia, while Aetna ended prior authorization for physical therapy in five states.

Prior authorization is particularly common in Medicare Advantage plans. KFF found that Medicare Advantage plans received 35 million prior authorization requests in 2021, 2 million of which were denied.

The 2024 Medicare Advantage and Part D final rule requires prior authorization approvals to be valid as long as medically necessary. In addition, the rule requires healthcare professionals with relevant expertise to review coverage denials based on medical necessity before plans can issue a denial. The rule also mandates Medicare Advantage plans to review utilization management policies annually.