Transforming prior authorization: What benefits professionals need to know for 2025

For benefits professionals, compliance is more than an obligation—it’s an opportunity to streamline care access, reduce frustrations, and enhance the overall employee benefits experience.

Prior authorization has long been a contentious process in health care. Providers often see it as a barrier to patient care, while health plans recognize the process as essential for cost control and care quality. As we head into 2025, however, regulatory shifts and technological advancements are transforming prior authorization into a tool that benefits professionals can leverage to improve employee health outcomes and satisfaction.

The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)–of which some provisions are set to take effect by 2026–mandates faster decision-making, improved transparency, and better data sharing throughout the prior authorization process. Combined with state-level reforms, these changes will require both health plans and benefits administrators to innovate. For benefits professionals, compliance is more than an obligation—it’s an opportunity to streamline care access, reduce frustrations, and enhance the overall employee benefits experience.