Meanwhile, some who support curbs on prior authorization caution that the new state laws might not make much of a difference, largely because they lack strong enforcement mechanisms.

Ron Howrigon, a former executive at insurance giant Cigna and current president of Fulcrum Strategies, a firm specializing in insurance contracts, said the laws are "better than nothing" and that "there are definitely some people [they're] going to help."

But, Howrigon said, insurance companies are adept at finding ways to get around laws designed to hold them accountable, especially if the only type of enforcement against them involves third-party reviews or relatively small fines.

"Nobody should kid themselves and think that patients aren't going to have to deal with incorrect denials," Howrigon told Stateline. "Because that's not right."

Furthermore, state laws generally apply to state-regulated private health insurance plans, which excludes the 65% of people who work for large firms and are covered by self-funded employer plans. And many of the state laws don't apply to people on Medicaid, the joint state-federal health care program for people with low incomes, according to the National Association of Insurance Commissioners.

Earlier this year, the federal Centers for Medicare & Medicaid Services finalized a rule designed to speed up prior authorization in government insurance programs, including Medicaid and Medicare, the federal health care insurance program for people aged 65 and over and the disabled. The new rule, most of which will go into effect in 2026, requires a decision on "urgent" requests within 72 hours. But it applies only to "medical items and services," not drugs.

'Fed up'

Dr. Amy Faith Ho, an emergency medicine physician in Dallas, said many patients whose treatments are delayed or denied through prior authorization often end up in her waiting room.

"At some point they just get fed up. But what's sad to me is they did everything right," Ho said. She added that some patients with chronic illnesses don't end up in the emergency room, but they do experience a loss in quality of life. "We see those patients sometimes present as suicide attempts," she said.

For patients with certain diseases and conditions, such as cancer, prior authorization delays and denials are a common occurrence: A 2023 study found that 1 out of every 5 cancer patients did not receive the care recommended by their treatment team because of the prior authorization process. In a 2022 survey conducted by the American Medical Association, 94% of doctors said prior authorization had led to a delay in care, and a third reported that prior authorization had led to a "serious adverse event" for a patient in their care.

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