Welcome to our April 2026 update on electronic Prior Authorization (ePA)! This section describes the current prior authorization process, how it could be improved, and gives you up to date information on electronic prior authorization.
Several vendors and internal patient support programs are already coordinating the completion of PA claim forms online with physicians and patients. Payers are accepting mailed/faxed print outs.
Some payers are actively exploring opportunities to receive claim forms electronically, or use AI to eliminate claim forms all together, as well as automate prior authorization adjudication. These explorations will take time to develop, pilot and launch on a large scale.
Look to mid 2026 before the first of these solutions are available on a limited basis in the marketplace.
New developments in prior authorization administration and adjudication will create wider gaps between the levels of service payers can deliver to plan sponsors and their plan members. Advisors and plan sponsors will need to increasingly exercise due diligence in examining their choice of payer to identify those with the most effective and cost efficient prior authorization practices and processes, including ePA. Payer accreditation through the Prior Authorization Framework and Accreditation (PAFA) Program, both administration excellence and ePA, will help advisors and plan sponsors in their evaluation process. Look for payers using the PAFA membership and accreditation branding.
The Simplify Prior Authorization initiative is an advocate for education about prior authorization (PA) and improvement in current prior authorization practices and processes. If your organization is interested in finding out more, getting involved, or in sponsorship of this important initiative, please contact us via the link below.