Five of the country’s biggest employers have signed on to a federal push to move prior authorization off fax machines and phone lines, a step that could eventually reach the millions of workers whose health benefits are paid for directly by the companies they work for.
Amazon, Google, Meta, Oracle and Axon Enterprise signed a statement of support asking the companies that run their health plans to adopt the same electronic prior authorization tools that insurers promised to build last year, the Centers for Medicare & Medicaid Services and the U.S. Department of Labor announced Wednesday.
“Patients and doctors shouldn’t have to fall back on faxes and paperwork simply because of how a patient’s health plan is funded,” CMS Administrator Dr. Mehmet Oz said.
What did the employers agree to do?
The employers did not take on a new legal obligation. They signed a statement of support that encourages their third-party administrators, the firms that process claims and handle approvals for self-funded plans, to extend the 2025 Prior Authorization Pledge to the plans those employers sponsor.
In practice, that means pressing administrators to offer standardized electronic prior authorization, faster answers and the other changes insurers promised for their fully insured business. CMS said more employers can join by contacting the agency.
Health and Human Services Secretary Robert F. Kennedy Jr. said the goal is reforms that reach “millions of Americans in self-funded plans.” Daniel Aronowitz, who leads the Labor Department’s Employee Benefits Security Administration, called it government and private industry “working together on behalf of the American workforce.”
Why do self-funded health plans matter so much?
Most people with job-based coverage are in a self-funded plan, even if the card in their wallet carries the name of a big insurer. In a self-funded plan, the employer pays the medical bills and hires an insurer or another company only to run the plan.
According to Census data cited by CMS, more than 53% of Americans, or more than 180 million people, get coverage through employers that sponsor self-funded plans. Those plans fall under federal benefits law enforced by the Labor Department rather than state insurance regulators, and many of the prior authorization rules aimed at Medicare Advantage, Medicaid and marketplace plans do not reach them.
That gap is why the Labor Department is part of this effort. Its benefits agency works directly with employer plans, while CMS has been leading the push with insurers and technology companies.
In June 2025, Kennedy and Oz brought together major insurers, including UnitedHealthcare, Aetna, Cigna, Elevance Health, Humana, Centene and Blue Cross Blue Shield plans, which promised six changes for plans covering nearly 8 in 10 Americans.
They pledged to standardize electronic submissions, cut the number of services that need approval, honor existing approvals when patients switch plans, explain decisions more clearly, give real-time answers for most requests by 2027 and have medical professionals review all clinical denials.
Separately, a CMS rule requires Medicare Advantage, Medicaid and marketplace plans to have electronic prior authorization systems in place starting Jan. 1, 2027. Industry groups reported in April that insurers had eliminated about 11% of prior authorization requirements under the pledge.
Do doctors think the pledge is working?
Physicians remain skeptical. In an American Medical Association survey of 1,000 practicing doctors, only 33% said the insurer pledge would make a meaningful difference.
The same survey found physicians complete an average of 40 prior authorization requests a week, consuming about 13 hours of doctor and staff time. Ninety-five percent said prior authorization delays needed care, and 26% said it had led to a serious adverse event for a patient, such as a hospital stay.
Only 24% of doctors said denials are consistently reviewed by an appropriately qualified clinician, one of the core promises insurers made. “Physician trust in voluntary insurer pledges is deeply eroded after years of unfulfilled promises,” AMA President Dr. Bobby Mukkamala said.
What changes for workers, doctors and employers?
Nothing changes overnight. The statement is voluntary, it names no deadline, and it depends on administrators building and switching on the technology. For employees at the five companies, the most likely near-term effect is faster electronic decisions as their plan administrators roll out the same systems they are building for Medicare and Medicaid plans.
For doctors’ offices, the bigger prize is consistency. Today a practice may submit one request through a payer portal, another by fax and a third by phone, depending on the patient’s plan. One electronic standard across government and employer coverage would cut the hours staff spend chasing approvals.
For other employers, the announcement is a signal that the administration wants self-funded plans in the tent. Employers that buy benefits through large administrators may find it easier to ask for pledge-level service now that some of the biggest names in tech have done so. Insurer practices have drawn growing scrutiny, including our recent report on insurer “ghost networks” in mental health care.
Key takeaways
- Amazon, Google, Meta, Oracle and Axon backed expanding electronic prior authorization to their self-funded health plans, CMS and the Labor Department said on Oct. 21, 2026.
- More than 180 million Americans get coverage through self-funded employer plans, which are largely outside the federal prior authorization rules for Medicare Advantage, Medicaid and marketplace plans.
- The move extends the June 2025 insurer pledge, which promised electronic submissions and real-time answers for most requests by 2027.
- The commitment is voluntary, with no deadline, and an AMA survey found only a third of doctors expect the pledge to make a meaningful difference.
Frequently asked questions
Which employers joined the CMS prior authorization effort?
Amazon, Axon Enterprise, Google, Meta and Oracle signed the employer statement of support announced by CMS and the U.S. Department of Labor on Oct. 21, 2026.
What is a self-funded health plan?
It is a plan in which the employer pays workers’ medical claims itself and hires an insurer or third-party administrator to run the plan. More than half of Americans are covered by one, according to Census data cited by CMS.
Is the employer prior authorization commitment mandatory?
No. It is a voluntary statement of support that encourages third-party administrators to bring the 2025 Prior Authorization Pledge to self-funded plans. No deadline was announced.
When will electronic prior authorization be required?
A CMS rule requires Medicare Advantage, Medicaid and marketplace plans to offer electronic prior authorization starting Jan. 1, 2027. Insurers also pledged real-time answers for most requests by 2027.
