States pursued multiple approaches to reduce prior authorization barriers in 2025, with gold card programs leading reform efforts. Arkansas, Texas, and West Virginia amended existing gold card legislation, while Iowa's pilot program was removed. Indiana and Montana established 24-48 hour review timeframes and coverage continuity requirements. Maryland restricted AI use in determinations, requiring patient-specific data and human physician oversight for adverse decisions.

Virginia and Utah wrapped up their sessions with significant healthcare legislation. Both states enrolled legislation that stands to have significant influences to the state of healthcare delivery and coverage and public health.

In 2025, state lawmakers are expected to prioritize healthcare affordability and access, building on key legislative trends from this year. Here are our thoughts on key trends and issues from 2024 and how they might show up in state capitols next year.