In June 2025, dozens of health insurers pledged six fixes to prior authorization. A year later, the AMA found that just 24% of physicians say denials are consistently reviewed by an appropriately qualified clinician, and Colin Banas, M.D., M.S.H.A., chief medical officer of DrFirst, says the process is as bad as ever.

Physicians Practice Managing Editor Keith Reynolds sat down with Banas to go through the pledge commitment by commitment and to look ahead to Jan. 1, 2027, when the CMS Interoperability and Prior Authorization final rule stops asking payers to cooperate and starts requiring it. Banas explains what has to be built by then, where he expects the deadline to break down and the two things a practice can do this month to be ready.

Music Credits:
Sky Drifter by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:10 | Cold open. Banas previews the episode's central worry: that digitizing prior authorization may not fix a process that was broken by design.

0:10 – 1:14 | Introduction. Austin Littrell introduces the episode and the guest.

1:14 – 1:32 | Meet Colin Banas. Keith Reynolds introduces DrFirst's chief medical officer and returns to his skepticism from a year ago.

1:32 – 2:56 | Who's watching the watchmen? Banas says he feels vindicated, and explains why: almost all the evidence that the pledge is working comes from the insurers who made it, with no external validation.

2:56 – 4:57 | The six pillars. What insurers actually committed to, from qualified clinical review of appeals to standardized electronic prior authorization and real-time approvals.

4:57 – 8:50 | What actually got delivered. Banas goes pillar by pillar. Only 24% of physicians report seeing specialty-matched review, the reduction claims are self-reported, and two of the six commitments were federal mandates already in motion. "It feels like taking credit for something that you were going to have to do anyway."

8:50 – 11:24 | "It's as bad as ever." Prior authorization friction has passed EHR friction as physicians' leading administrative complaint. Rooms with fax machines, clinical teams running six browsers for six payers, and what Banas calls a non-unified, wasteful experience.

11:24 – 13:32 | What has to be built by 2027. The four APIs every player in the ecosystem needs, and why the medical benefit and the prescription benefit are on separate tracks.

13:32 – 14:37 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

14:37 – 16:56 | The retrospective prior authorization. Why finding out at the pharmacy counter is "almost insanity," why the best prior authorization is the one that never happens, and why Banas wants the process as transparent as a pizza tracker.

16:56 – 18:41 | Where the deadline breaks down. Banas points at payers and vendors first and enforcement second, drawing the parallel to the early years of the information blocking rule.

18:41 – 19:33 | If the pipes get built and nothing changes. What persistent delays would prove about how the whole system is incentivized.

19:33 – 21:48 | Credit where it's due. Activated patients, payers expanding gold carding, and why taking 80% of the work off a practice's plate still counts as meaningful progress.

21:48 – 23:15 | Two things to do this month. Get a straight compliance answer from your EHR or e-prescribing vendor, and start tracking approvals, denials and reversals now so you have a baseline to measure against.

23:15 – 24:46 | Closing thoughts and outro. Banas asks to do it again in six months and ends on a positive note. Littrell wraps the episode.

S1 Ep178: A year after the prior authorization pledge, what changed? with Colin Banas, M.D., of DrFirst

Off the Chart: A Business of Medicine Podcast

S1 Ep178: A year after the prior authorization pledge, what changed? with Colin Banas, M.D., of DrFirst