Governor Hochul and State Legislature Must Reform Prior Authorization Process in Final FY2026 Budget
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Colleagues:
MSSNY is urging Governor Kathy Hochul and the State Legislature to finally reform the broken prior authorization system as part of the FY2026 final budget, a system that continues to delay patient care, interfere with treatment decisions, and place unnecessary burdens on physicians and patients.
Last summer, more than 60 health insurers including UnitedHealthcare, Aetna, Cigna, Humana, Elevance Health, and plans affiliated with the Blue Cross Blue Shield Association publicly pledged to improve the prior authorization process by reducing barriers to care and easing administrative burdens on physicians. Yet physicians across New York continue to see little meaningful change in their daily practice or in their patients’ experiences.
New data from the American Medical Association reflects the frustration and skepticism many physicians feel after years of promises that have failed to materialize. Several important reforms were proposed in this year’s Executive Budget, along with comprehensive legislation sponsored by Assemblymember David Weprin and Senator Gustavo Rivera. MSSNY believes the time has come to move beyond discussion and enact meaningful change.
The AMA survey paints a troubling picture of the real-world consequences of prior authorization requirements:
- More than one in four physicians (26%) report that prior authorization has led to a serious adverse event for a patient, including hospitalization, permanent impairment, or even death.
- Ninety-five percent of physicians say prior authorization delays access to necessary care.
- Nearly four in five physicians (79%) report that patients abandon treatment because of authorization obstacles.
- Ninety-two percent say prior authorization negatively affects patient outcomes.
For physicians and our patients, these are not abstract statistics. Prior authorizations place overwhelming burdens on physicians and create unnecessary delays in needed patient care. Too often, patients are left waiting for approval of prescriptions, tests, or procedures while they are already dealing with fear and uncertainty about their health. These delays create needless anxiety for patients and families and undermine the ability of physicians to use their clinical judgment to provide timely care.
The growing administrative burden on physicians also continues to take valuable time away from patient care. A recent study published in the Annals of Internal Medicine found that for every hour physicians spend caring for patients, they spend two additional hours on administrative tasks. Much of that time is consumed by insurance-related requirements such as prior authorization.
Patients living with chronic illnesses are especially vulnerable to these delays. Many depend on carefully managed treatment regimens to maintain their health and quality of life. When medications or treatments are delayed because of insurance authorization requirements, the consequences can be serious, interrupted treatment, worsening disease progression, avoidable complications, and increased emotional stress for patients and their families.
Every patient deserves the peace of mind that medically necessary care will be available when they need it, not after unnecessary delays or bureaucratic hurdles. MSSNY is calling on state leaders to take meaningful action now and deliver reforms that protect patients, support physicians, and restore timely access to care across New York State. Join me in urging your legislators to support prior authorization reform. Help finance the fight at MSSNYPAC.
All the best,
Mark J. Adams, MD, MBA, FACR
MSSNY President
