Cigna eliminates prior auth requirements for 25% of codes

Cigna is eliminating prior authorization requirements from 600 diagnostic codes in a bid to streamline the experience for both members and providers.

The 600 codes represent nearly 25% of those that currently require prior auth, Cigna said in an announcement. This builds on several years of work to ease prior authorization barriers, Cigna said; since 2020, the company has removed prior auth on about 1,100 codes.

Cigna said that with the latest update, prior authorization applies to less than 4% of services for most of its members.

"Our goal is to help keep patients safe, improve health outcomes, and make care more affordable, and this important step will enable us to do that while removing administrative burdens on the health care system," said David Brailer, M.D., executive vice president and chief health officer for The Cigna Group, in the release.

"We've listened attentively to our clinician partners and are deliberately making these changes as a result," Brailer added. "We will continue to hold ourselves accountable for this important work and look forward to building on this momentum in the future."

Cigna said it will also remove prior authorization from 500 codes in Medicare Advantage.

Providers have long pointed to prior authorization as an onerous process that leads to lengthy wait times for patients and worsens their administrative burnout. Payers, however, argue that prior auth and other utilization management tools are critical to ensure patients are receiving the appropriate care at the right time.

Policymakers have mulled overhauls to prior authorization requirements, and the Centers for Medicare & Medicaid Services is weighing a shift to electronic prior authorization, which makes approvals far faster.

"Prior authorizations are an important step to ensure patient safety and affordability, but clinicians and health plans alike agree that more can be done to reduce the administrative burden on clinicians," said Scott Josephs, M.D., chief medical officer at Cigna Healthcare, in the release. "We will continue to engage with clinicians to align on care delivery goals and outcomes and evaluate whether there are other changes we can make without compromising patient safety."