AMA presses CMS to hold the Jan. 1, 2027, deadline for electronic prior authorization

The American Medical Association (AMA) urged the Centers for Medicare & Medicaid Services (CMS) on Friday to keep the Jan. 1, 2027, compliance date for electronic prior authorization (ePA) and to reject broad enforcement discretion during 2027.

A year of nonenforcement would leave physicians reliant on “faxes, phone calls, payer portals, and repeated data entry while patients continue waiting for medically necessary care,” AMA CEO John Whyte, M.D., M.P.H., wrote in a letter to Administrator Mehmet Oz, M.D.

The AMA’s 2025 prior authorization physician survey found 95% of physicians report that prior authorization delays access to necessary care and 26% report it has led to a serious adverse event for a patient in their care. The process consumes an average of 13 hours of physician and staff time each week. The survey polled 1,000 practicing physicians in December 2025.

“Without clear and timely information, practices cannot build change management plans, train staff, participate in testing, or serve as active partners in improving ePA so it delivers on its promise,” Whyte wrote.

The information he describes maps to what a practice would need from its electronic health record (EHR) vendor and its payers well before January: what functionality will be available on Jan. 1, how workflows will change, what limitations and fallback processes to expect, how the technology is expected to improve over the course of 2027 and where to report technical failures and workflow problems when they surface.

A catch-22 over physician uptake

Health plans are citing limited physician engagement with ePA to justify a delay while mischaracterizing that engagement as a lack of physician interest, according to the letter. Physicians “are portrayed as unwilling to use ePA, yet physicians are not receiving needed education and support from health plan and EHR developer partners, which perpetuates physician ‘unwillingness,’” Whyte wrote. “This is a manufactured problem created to justify a delay.”

What the AMA wants from vendors and payers

CMS should call on EHR developers to give physician customers implementation timelines, testing opportunities, training, technical support and clear information about planned functionality, the letter says.

Health plans should conduct regular outreach to EHR developers to confirm connections are built and tested, and should reach out to contracted physicians with education and support.

“EHRs are only one facet of ePA, and health plans bear a significant responsibility for success,” Whyte wrote.

Health plans also must make accurate, current prior authorization and documentation requirements available through their application programming interfaces (APIs) and ensure those connections function reliably, the letter says. As the deadline approaches, it adds, reliance grows on third parties to complete “the last mile” of implementation, and those vendors are not subject to CMS oversight and enforcement.

The letter asks CMS to give physicians a clear set of questions to put to their EHR developers and health plans now, and says the AMA can help the agency develop them.

The rule behind the date

The Jan. 1, 2027, date comes from the CMS Interoperability and Prior Authorization final rule (CMS-0057-F), which requires affected Medicare Advantage organizations, state Medicaid and Children’s Health Insurance Program (CHIP) fee-for-service programs, Medicaid and CHIP managed care entities and qualified health plan issuers on the federally facilitated exchanges to implement a prior authorization API that identifies documentation requirements and carries requests, approvals and denials.

Drug prior authorizations are not covered, and exact compliance dates vary by payer type.

Electronic prior authorization interfaces from affected payers go live Jan. 1, 2027, and their use is to be folded into the Merit-based Incentive Payment System for clinicians and the Medicare Promoting Interoperability Program for hospitals. CMS has estimated the policies will save about $15 billion over 10 years.

Since January 2026, affected payers have had to return decisions on medical items and services within 72 hours for expedited requests and seven calendar days for standard ones.

“Staying steadfast will protect patients, prepare physicians, and secure the Administration’s legacy of making ePA work in practice, not merely on paper,” Whyte wrote.

CMS had not responded publicly to the letter as of publication.