CMS's final rule sets the clocks for the big payers: 72 hours for urgent prior authorization requests, 7 calendar days for standard, with specific denial reasons required from 2026. Your leverage: urgent filing when warranted, a completeness check with the doctor's office, and a bridge fill from the pharmacy while it runs.
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What to do
Common questions
How long does prior authorization take?
The honest answer has a federal floor and a practical reality. The floor: under CMS's 2024 Interoperability and Prior Authorization final rule, the large payers it regulates - Medicare Advantage, Medicaid managed care, CHIP, and marketplace plans - must send prior authorization decisions within 72 hours for expedited (urgent) requests and 7 calendar days for standard requests, taking effect in 2026. The practical reality: timing still depends on whether the submission was complete, whether it was marked urgent, and how your plan handles the queue - a missing lab result or vague note sends it back rather than forward. You have more influence than you think. Make sure the doctor's office files it as urgent when waiting would risk your health - the urgent clock is three days, not seven. Call the office (not the plan) two days after filing to confirm it went in complete; call the plan's member line a few days later for status. If a medicine is needed now, ask the pharmacist about a short emergency supply while the authorization runs - many plans and states allow a bridge fill. And if the answer comes back no, that is a checkpoint, not an endpoint: from 2026 payers must give the specific denial reason, your doctor can appeal with medical-necessity detail, and denials with a solid letter behind them often reverse. Pymander is a free AI doctor, 24/7 by text, and can help you work out what to say to the office.