Colorado has passed a new prior authorization reform law, set to take effect on January 1, 2026. The legislation aims to address ongoing concerns about the administrative burdens and patient care delays caused by current prior authorization practices used by health plans.
The Colorado Medical Society (CMS), along with specialty societies and a coalition of patient stakeholders led by CMS, played a central role in advocating for these changes. According to the American Medical Association (AMA), “Thanks to the persistent and highly effective advocacy work of the Colorado Medical Society (CMS), its partner specialty societies, and a CMS-led coalition of patient stakeholders, Colorado has enacted a prior authorization reform law that takes effect Jan. 1, 2026 that will rein in health plans’ use of this onerous cost-control measure that endangers patients, wastes resources and undermines the expertise of physicians.”
One major change under the new law is that prior authorization approvals will be valid for up to one year or for the duration of treatment. This is an extension from the previous period of 180 days. The law also introduces requirements for greater transparency in prior authorization rules and mandates improved data reporting from health plans so there is more accountability.
Additionally, Colorado lawmakers have coordinated automation efforts with federal initiatives to streamline the process through electronic health records (EHRs). This means physicians can avoid using multiple online portals and logins when submitting requests. There are also protections ensuring that once a prior authorization is approved, payment cannot be retroactively denied.
The Health Can’t Wait Colorado campaign was instrumental in gathering stories from patients and doctors about their experiences with prior authorizations. These accounts helped persuade legislators that reforms were needed.
According to AMA leadership: “Achieving meaningful prior authorization reform in the Rocky Mountain State – and ensuring that more health care decision-making takes place between patients and physicians – was due in large part to the Health Can’t Wait Colorado campaign coordinated by CMS. This effort to collect firsthand prior authorization experiences from patients and physicians helped convince state lawmakers that real reform was needed now.”
The AMA has made streamlining prior authorizations a national priority. As stated: “As the physician’s powerful ally in patient care, the AMA has been working closely with CMS and our other partners in the Federation of Medicine to streamline and simplify a process that has morphed from a rarely used tool intended to limit the use of expensive, newly introduced medications or treatments into a utilization management strategy that payers regularly invoke before patients can receive even the simplest generic medications or time-proven, evidence-based treatments.”
Personal anecdotes continue to highlight ongoing issues with existing systems across states like Michigan. As described: “Prior authorization hassles remain a source of endless frustration for me, my small staff and our patients in Flint, Mich… Even though I have been practicing for a quarter-century, my name failed to appear on physician roster compiled by the largest insurer in my home state of Michigan.”
Looking ahead, new federal policies require insurers participating in Medicare or Medicaid programs to accept electronic submission of prior authorizations (ePA), which is expected to reduce paperwork and speed up responses. The integration between state laws like Colorado’s reforms and federal ePA requirements is designed so providers can transition more smoothly as these technologies are adopted nationwide.
The AMA notes: “Electronic prior authorization (ePA) is on the horizon. New policies from the Centers for Medicare and Medicaid Services require health plans to accept, track and return PA decisions electronically, which will cut wait times and paperwork. Colorado physicians are lucky to have a state medical society leading the way in connecting state automation requirements with these new federal rules through state law, to ensure the most streamlined and least burdensome transition.”
Physicians are encouraged to contact their EHR vendors about timelines for ePA readiness so they can prepare staff workflows ahead of wider implementation anticipated by 2027.
