Aetna, a CVS Health company, is expanding its bundled prior authorization program across all cancer types for members in eligible Medicaid states as of September 1, with plans to extend it across all lines of business in 2027. The expansion builds on an initial roll-out in which almost 25% of eligible members received a bundled prior authorization, assuring their services were approved in advance. Aetna found that providers were submitting four separate prior authorizations on average for each member needing cancer treatment, and the bundles combine medical oncology, including chemotherapy and immunotherapy where appropriate, and radiation oncology services with associated high-tech imaging such as MRI or CT scans into a single request through one portal. Katerina Guerraz, Aetna Chief Operating Officer and President of Medicaid, said approving a broader set of treatments and related services upfront removes barriers that can delay care. According to the latest Aetna Provider Survey, 74% of providers identified administrative burden as the top challenge facing clinical staff, and nearly one-third, or 31%, cited prior authorization management as the single largest contributor; 30% of respondents believed they could save more than an hour and 80% expect to save more than 30 minutes daily through technology solutions such as bundles. Aetna expects to expand eligibility to Medicare and Commercial members in the first half of 2027.
CVS Health CorpAetna (CVS Health) expands its bundled prior authorization program to all cancer types for Medicaid members, streamlining approvals and reducing administrative burden.
