Prior Authorization Denial Rates Range from 2% to 25% Across Health Plans
Prior authorization denial rates varied from 2% to 25% among health insurers in 2025, according to a KFF analysis of newly released data mandated by CMS. The analysis reveals significant variation in how plans approve or deny coverage requests for medical services and drugs. This represents the first time CMS has required health insurers to publicly disclose prior authorization denial data, providing unprecedented transparency into plan-level utilization management practices. The data allows Medicaid managed care plans, state agencies, and regulators to benchmark denial patterns and assess whether authorization practices align with medical necessity standards and contract requirements.
State Medicaid agencies can now compare MCO prior authorization practices against national benchmarks to identify outlier plans with potentially inappropriate denial patterns that may warrant contract oversight or corrective action.
Managed Care
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