Colorado has enacted a new prior authorization reform law, set to take effect on January 1, 2026. The law is the result of advocacy efforts led by the Colorado Medical Society (CMS), partner specialty societies, and a coalition of patient stakeholders coordinated by CMS.
The American Medical Association (AMA) supported CMS throughout this three-year campaign. The new law extends prior authorization approvals from 180 days to one year or the length of treatment. This aims to protect continuity of care for patients and reduce administrative work for physicians. The legislation also introduces greater transparency in prior authorization requirements and enhances data reporting, which is expected to improve accountability among health plans.
Another provision aligns Colorado’s automation efforts with federal initiatives, allowing physicians to process prior authorizations directly within electronic health records instead of using multiple portals. Physicians will also have assurance that approved authorizations will be honored for payment without retroactive denials.
“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,” according to the statement.
The AMA highlighted ongoing challenges with prior authorization nationwide, describing it as a process that has shifted from its original intent—limiting expensive or new treatments—to a common requirement even for generic medications or established therapies.
“Prior authorization hassles remain a source of endless frustration for me, my small staff and our patients in Flint, Mich. Hassles may be too mild a term. Just a few months ago, a member of my staff had to call an insurer over a prior authorization issue because ‘Mukkamala’ wasn’t coming up as a provider in their system. 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,” said the AMA president.
“This is an isolated example, to be sure, but also a symptom of an unsustainable process that must be changed. To fully gauge the depth of this problem and the reforms we need, you can see other physicians share some of their very worst experiences with prior authorization here.”
Electronic prior authorization (ePA) technology is expected soon. New policies from the Centers for Medicare and Medicaid Services require health plans to handle these requests electronically—a move anticipated to reduce delays and paperwork. The AMA noted that Colorado’s integration of state automation requirements with federal rules through its new law positions it at the forefront as these changes roll out nationally.
“The AMA is ensuring the physician voice is front and center in ePA development. The goal is for EHR systems to fire off requests and receive instant responses, turning today’s fax-and-phone marathon into a seamless ‘electronic handshake.'”
“For medical practices, that future starts with a question: When will my EHR be ePA-ready? Ask your vendor for the upgrade timeline, pilot opportunities, and any training or interface costs. Early engagement lets you shape workflows, prepare staff, and position your practice to reap the efficiencies — and faster patient care — once payers flip the switch in 2027.”
