Commercial insurer prior authorization (PA) rules are published in provider manuals that are often hundreds of pages long. Physicians report that the complexity of PA rules, forms, and submission protocols contributes to delays in care, adverse events, and burnout. Physicians, insurers, and legislators support the transition to electronic PA, but differences across insurers hinder digitization. In 2022, 97% of medical plans reported fully digital claims submissions, but only 28% reported fully digital PA. Study of PA rules has been limited to Medicare Advantage plans.