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AAOS Now / Issue: Jun 2026 / advocacy05

AAOS Now

Published 6/22/2026
Advocacy Practice Management

AAOS firmly backs wide-sweeping prior authorization reform

AAOS believes broad reforms to prior authorization are necessary to ensure physicians can quickly provide safe and effective treatments to their patients. AAOS supports both federal and state-level legislative and regulatory solutions to reform the system.

In 2025, many states addressed prior authorization through reform efforts, including system modernization and efforts to address payer use of artificial intelligence in the prior authorization process. The issue of AI has been challenging, especially after President Trump issued an executive order in 2025 threatening legal action against states that regulated AI systems. States such as Nevada have even seen legislation (SB 128) passed by both houses, only to then be vetoed by the governor. Despite this, states have continued to introduce legislation to address the use of AI systems in utilization review.

States are also attempting to address utilization review through Gold Card programs that exempt physicians from prior authorization requirements for specific service if the physician has previously had a very high percentage of their prior authorizations for the service approved. In July 2025, the Oregon legislature passed HB 3134, which reformed the criteria for exemption from prior authorization requirements, lowering the threshold for a physician’s prior authorization request approval rate from 90% to 80% over the prior 12 months. In Texas, HB 3812 was successfully passed into law, easing physicians’ ability to secure gold card exemptions while creating stronger regulations against arbitrary and wrongful denials.

Help advocate for the profession with resources in the Advocacy Action Center: aaos.quorum.us.

References

  1. Dyrbye LN, West CP, Satele D, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443-451. Doi:10.1097/ACM.0000000000000134
  2. Eisenstein L. To Fight Burnout, Organize. N Engl J Med. 2018;379(6):509-511. Doi:10.1056/NEJMp1803771
  3. American Medical Association, American Medical Association. Physicians concerned AI increases Prior Authorization denials. American Medical Association. https://www.ama-assn.org/press-center/ama-press-releases/physicians-concerned-ai-increases-prior-authorization-denials. Published February 24, 2025.