2026 Prior-Authorization Decisions Get Clearer

In 2026, affected plans had to send prior-authorization decisions for medical items and services within 72 hours for urgent requests and seven days standard.
The rule affected Medicare Advantage, Medicaid and children's managed-care programs, plus some exchange plans; it did not cover every plan or drug authorization.
Denied requests now required specific reasons, helping patients and providers identify missing documents, medical-necessity issues, network problems, or other coverage conditions before resubmitting or appealing.
When care is delayed, patients can ask whether review is standard or expedited, confirm the plan received everything, and request any denial reason in writing.
The 2026 changes focused on process and timeliness, while broader standardized electronic interfaces were generally slated for Early-Q1 2027, aiming for clearer status visibility.