Gold Carding

Gold carding is a health plan program that exempts high-performing physicians from prior-authorization requirements for specific procedures or drug categories, based on their track record of having previous prior-authorization requests approved at a very high rate. The idea is that a physician who's been right nearly every time doesn't need to keep asking permission — the plan agrees to skip the prior-auth step for that physician's future requests in the category.

The program has been driven by physician associations and state legislatures frustrated with prior-authorization delays. Texas passed HB 3459 in 2021 requiring commercial plans to establish gold-carding programs — physicians whose PA requests have been approved at a 90 percent rate or higher across a defined lookback period are exempt from PA on future requests for that specific service. Other states have followed with similar laws. Medicare Advantage plans and commercial carriers vary in their implementation: some carriers have embraced gold-carding as a way to reduce administrative friction with high-volume specialists, others have implemented it narrowly with high approval-rate thresholds and short lookback windows. The physician-side benefit is real — a specialist doing dozens of prior authorizations a month can eliminate meaningful staff time. From the plan-sponsor perspective, the concern is whether gold-carding actually reduces unnecessary utilization or just removes a friction point that was previously slowing down borderline requests.

The takeaway: if you're a physician practicing in Texas or another state with gold-carding legislation, ask each of your commercial payers directly whether you're gold-carded for specific services. Many programs are opt-in and don't automatically apply your approval history.