AI in Access and Prior Authorization: A Payer Perspective on What Actually Works

AI is increasingly being applied across patient access, prior authorization, and care management — but from a payer perspective, the focus is less on what is technically possible and more on what is operationally viable, clinically appropriate, and scalable.

As health plans and pharmacy benefit managers deploy AI to support prior authorization workflows, manage formulary transitions, and identify patients for care management programs, new questions are emerging around trust, oversight, and real-world impact. While these tools have the potential to reduce administrative burden and improve patient outcomes, their success depends on how well they integrate into existing systems and align with clinical and coverage decision-making processes.

This session brings a payer-led perspective to how AI is being used in practice today. Drawing on real-world experience, the discussion will explore where AI is delivering measurable value, where it is falling short, and what it takes to implement these tools responsibly at scale.

Join us to discuss:

• How AI is being used across prior authorization, formulary management, and care programs
• What has worked in real-world deployment
• What it takes to build trust, ensure oversight, and scale AI within payer environments