Embargoed for release until 5:00 p.m. ET on Monday 18 May 2026
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine . The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. Prior authorization rules vary widely among major commercial insurers
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-05289
URL goes live when the embargo lifts
A brief research report reviewed the prior authorization rules for Aetna, Humana, and UnitedHealthcare and found little consistency in their prior authorization rules. The findings highlight a fragmented system that may contribute to administrative burden for clinicians and confusion for patients. The report is published in Annals of Internal Medicine .
As part of a research program on the potential benefit of standardizing health care contracts, researchers from Stanford University and colleagues examined how prior authorization rules vary across commercial insurers and whether those rules could be organized into a single, searchable database like the ICD-10 system. They analyzed publicly available provider manuals from Aetna, Humana, and UnitedHealthcare, reviewing thousands of procedure and service codes to determine when prior authorization was required and what information clinicians had to submit to the insurer to obtain authorization for a particular test or treatment. Using a combination of automated review and manual checks, they built a searchable database and used it to compare insurer rules. They found that while all three insurers required prior authorization for some services, the majority of services required prior authorization from only one of the three insurers, and the criteria and documentation requirements differed widely. The authors conclude that assembling these rules into a shared database is feasible and could improve transparency for both patients and clinicians, but the unexplained differences across insurers warrant further research on the appropriateness of this administrative barrier to patient receipt of some interventions ordered by their clinician.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author David Scheinker, PhD please email Errol Ozdalga at eozdalga@stanford.edu and Kara Clemins at kclemins@stanford.edu.
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2. ACP calls for reform of the Medicare Advantage Program to protect patient health
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04309
The Centers for Medicare and Medicaid Services (CMS) should reform Medicare Advantage to protect patient health and realign the plan option with its original purpose, says the American College of Physicians (ACP). In a new paper, “Protecting the Integrity and Quality of the Medicare Advantage Program: A Position Paper from the American College of Physicians” published in Annals of Internal Medicine , ACP examines growth of the Medicare Advantage program and its implications for the delivery of fair, high-quality and fiscally responsible care to older adults and people with disabilities.
Medicare Advantage is the private option in Medicare that now enrolls more than half of all Medicare beneficiaries. The plans are offered by private insurers approved by the CMS and integrate Part A and Part B of traditional Medicare coverage into a single plan with additional coverage options, such as prescription drugs, dental, vision and even gym memberships. The additional coverage appeals to beneficiaries, but beneficiaries often face challenges in navigating plan choices, unexpected costs, prior authorization and access to clinicians and post-acute services. These barriers disproportionately affect those who are low-income, live in rural communities, or have several chronic conditions. Medicare Advantage risk adjustment policies have created payment vulnerabilities and favorable patient selection, whereas quality measurement of the plans remains fragmented and overly complex.
In the paper, ACP details several position statements and recommendations for policymakers to ensure that traditional fee-for-service Medicare remains a strong, sustainable option for beneficiaries and advises that Medicare Advantage plans should not be used to replace or privatize traditional Medicare. These plans also must provide transparent, standardized benefit designs, which would improve beneficiaries' decision making, enhance accountability and ensure that plan offerings prioritize meaningful health benefits rather than serving as an incentive to select a plan. The transparency should extend to the promotion of Medicare Advantage plans, as well. ACP strongly advises robust oversight and regulation of Medicare Advantage marketing practices to prevent misleading advertisements and says that plans engaging in deceptive marketing should face penalties. Medicare Advantage plans should also be required to provide clear, standardized cost disclosures to protect beneficiaries from unexpected financial strain, and CMS should ensure that Medicare Advantage plans prioritize affordability alongside access to care. ACP says the plans should enact balanced and transparent risk adjustment mechanisms to better reflect patient complexity and avoid excessive coding practices.
Prior authorization requirements in Medicare Advantage plans are a common concern for physicians and patients due to administrative burden and potential delays in necessary care; ACP calls for streamlined prior authorization processes with faster response times and improved transparency. ACP also recommends that Medicare Advantage plans offer comprehensive and accessible telehealth options to benefit rural and underserved populations. The plans should also report to CMS and the public on the usage and outcomes of supplemental benefits, such as telehealth, dental, vision and hearing services to ensure accountability. Finally, ACP urges policymakers to prevent restrictive contractual clauses in Medicare Advantage models that interfere with physicians’ abilities to serve their patients. Regulatory frameworks should prioritize patient-centered care over administrative or financial considerations.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To speak with someone at ACP, please email Jacquelyn Blaser at jblaser@acponline.org.
Also new this issue:
How Big Is the “Gray Area”? Navigating Health-Threatening Previability Pregnancy Complications in States With Abortion Restrictions
Alyssa Bilinski, PhD, et al.
Ideas and Opinions
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-02397
Annals of Internal Medicine
News article
People
Variation in Commercial Insurer Prior Authorization Rules
19-May-2026