A year after the prior authorization pledge, what changed? with Colin Banas, M.D., of DrFirst

In June 2025, dozens of health insurers pledged six fixes to prior authorization. The commitments carried no enforcement. The federal requirements arriving Jan. 1, 2027 do, and they land on payers, on EHR vendors and, through a new attestation measure, on practices themselves.

Physicians Practice Managing Editor Keith Reynolds sat down with Colin Banas, M.D., M.S.H.A., chief medical officer of DrFirst and former chief medical information officer at VCU Health System, to go through the pledge commitment by commitment.

Banas was skeptical when the commitments were announced, and he says the past year has left him feeling vindicated. In this episode, he walks through the four APIs payers have to stand up, where he expects the deadline to break down, and the two assignments he would give a practice leader this month. Both are free. Read Keith Reynolds' full reporting on the insurer pledge.

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Music Credits:
Midnight Serenade by MORRIX Holyhold - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:10 | Cold open Banas previews the episode's central worry: that digitizing prior authorization may not fix a process that was broken by design.

0:10 – 1:14 | Introduction Austin Littrell introduces the episode and the guest.

1:14 – 1:32 | Meet Colin Banas Keith Reynolds introduces DrFirst's chief medical officer and returns to his skepticism from a year ago.

1:32 – 2:56 | Who's watching the watchmen? Banas says he feels vindicated, and explains why: almost all the evidence that the pledge is working comes from the insurers who made it, with no external validation.

2:56 – 4:57 | The six pillars What insurers actually committed to, from qualified clinical review of appeals to standardized electronic prior authorization and real-time approvals.

4:57 – 8:50 | What actually got delivered Banas goes pillar by pillar. Only 24% of physicians report seeing specialty-matched review, the reduction claims are self-reported, and two of the six commitments were federal mandates already in motion. "It feels like taking credit for something that you were going to have to do anyway."

8:50 – 11:24 | It's as bad as ever Prior authorization friction has passed EHR friction as physicians' leading administrative complaint. Rooms with fax machines, clinical teams running six browsers for six payers, and what Banas calls a non-unified, wasteful experience.

11:24 – 13:32 | What has to be built by 2027 The four APIs every player in the ecosystem needs, and why the medical benefit and the prescription benefit are on separate tracks.

13:32 – 14:37 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

14:37 – 16:56 | The retrospective prior authorization Why finding out at the pharmacy counter is "almost insanity," why the best prior authorization is the one that never happens, and why Banas wants the process as transparent as a pizza tracker.

16:56 – 18:41 | Where the deadline breaks down Banas points at payers and vendors first and enforcement second, drawing the parallel to the early years of the information blocking rule.

18:41 – 19:33 | If the pipes get built and nothing changes What persistent delays would prove about how the whole system is incentivized.

19:33 – 21:48 | Credit where it's due Activated patients, payers expanding gold carding, and why taking 80% of the work off a practice's plate still counts as meaningful progress.

21:48 – 23:15 | Two things to do this month Get a straight compliance answer from your EHR or e-prescribing vendor, and start tracking approvals, denials and reversals now so you have a baseline to measure against.

23:15 – 24:46 | Closing thoughts and outro Banas asks to check back in six months and ends on a positive note. Littrell wraps the episode.