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Hours after experiencing a flare-up related to chronic obstructive pulmonary disease, Kenney Blewett of Kyle, Texas, died by suicide in June. A medication his doctor prescribed days earlier to ease his breathing problems hadn’t been filled due to an “insurance issue,” his pharmacy explained via email.

Last year, the Trump administration announced a voluntary pledge by dozens of insurers to improve prior authorization, which often requires patients to seek approval before treatments. But prior authorization remains commonplace, and there’s no evidence the government is trying to hold insurers to account.

Last summer, the Trump administration announced a voluntary pledge by health insurers to reform prior authorization, which often requires patients or their doctors to seek preapproval from insurers before proceeding with medical care. Patient advocates and medical providers remain skeptical.

After Eric Tennant died, his widow vowed to speak out against West Virginia’s Public Employees Insurance Agency, which had denied cancer treatment recommended by Tennant’s doctor. Her efforts paid off. In March, West Virginia’s governor signed a bill to protect some patients from harm tied to prior authorization.

Medicare is testing the use of artificial intelligence to preapprove several healthcare services. Federal health officials say prior authorization can help reduce fraud and contain costs. But doctors and patients describe the trial as “horrendous” and full of red tape so far.

A Massachusetts woman knew the medicine her doctor prescribed required preauthorization, but she didn’t realize the approval had an expiration date. It took nearly three weeks of phone calls and paperwork to get her prescription refilled.