Healthcare organizations are finding that digitizing medical policy and implementing FHIR APIs does not automatically solve prior authorization delays at scale. The issue is that medical-necessity determinations remain hard to convert into executable rules for automated systems, leaving turnaround times slow and generating continued provider frustration. The report underscores that operational automation requires more than data standards; payer decision logic has to be translated into machine-executable workflows that reliably handle exceptions, clinical nuance, and jurisdiction-specific policy constraints. For biotech and device makers, this bottleneck can indirectly affect patient access to therapies and the speed at which outcomes data translate into real-world treatment. The ongoing lack of full automation suggests that improving prior authorization processes may require redesigning policy logic and integrating more robust rule engines. The take-away is practical: digitization can streamline interfaces, but it does not remove the need for domain-level rule authoring and validation across payer systems.