April 3, 2025
According to an MMA analysis of publicly posted Minnesota health plan data, the number of prior authorization (PA) requests in Minnesota has more than doubled over the past two years - from 227,549 in 2022 to 460,243 in 2024.
The analysis finds that 70% of this increase is attributable to Blue Cross Blue Shield of Minnesota products, and 24% of this increase is attributable to Medica products.
The analysis also finds that in 2024:
87% of initial PA requests were approved,
Only 19% of PA denials were appealed by providers/patients,
Of appealed requests, 84% were approved,
Overall, 89% of PA requests were ultimately approved (i.e., either initially or upon appeal).
The analysis is based on data required by a 2020 Minnesota law that requires Minnesota health plans to publicly post annual PA data on their websites.
Starting January 1, 2026, a new set of PA regulations championed by the MMA will take effect. Most notably, state-regulated health plans will be prohibited from requiring PA for:
treatment of a chronic health condition that has received PA under the current insurance provider, unless the standard of care has changed. "Chronic health condition" means a) expected to last at least one year and b) requires ongoing medical management to prevent adverse health events or limits at least one activity of daily living,
outpatient mental health and substance use treatment services, excluding medications,
antineoplastic cancer treatment consistent with guidelines of the National Comprehensive Cancer Network, excluding medications,
services with an A or B rating from the US Preventive Services Task Force,
immunizations recommended by the Advisory Committee on Immunization Practices,
preventive services for women as described in Code of Federal Regulations Title 45, Section 147.130,
pediatric hospice services, and
services delivered through a neonatal abstinence program operated by pediatric pain or palliative care specialists.
For more information, contact Adrian Uphoff, health policy analyst.
August 20, 2026
A physician and Olympian will give an inspirational address as part of this year's Empowering Physicians event on Friday, September 25, at the Minneapolis Institute of Art.
August 20, 2026
Minnesota received some disturbing news this week from the Centers for Disease Control and Prevention (CDC), as data shows that for the 2025-2026 school year, vaccination rates decreased and non-medical exemptions increased.
August 20, 2026
On August 11, a federal appellate court sided with the Texas Medical Association (TMA) argument that the way the No Surprises Act’s qualifying payment amount (QPA) is calculated has historically favored payers in arbitration.