Aetna expands bundled oncology prior authorizations, easing provider burden and accelerating member access to care
Aetna, a subsidiary of CVS Health, is expanding prior authorization bundles for all cancer types for eligible Medicaid members starting September 1. The company plans to roll out this initiative across all its lines of business in 2027. This expansion follows a successful initial phase, which saw nearly 25% of eligible members receive bundled prior authorizations, thereby streamlining access to care for patients in need of cancer treatment.
On average, Aetna noted that providers were submitting four separate prior authorizations for each member requiring cancer treatments. To address this, the company is now offering a single, secure prior authorization that encompasses a bundle of cancer treatments. These bundles include medical oncology services, such as chemotherapy and immunotherapy, as well as radiation oncology and necessary high-tech imaging services like MRIs or CT scans, all processed through a single submission portal.
Katerina Guerraz, Aetna's Chief Operating Officer and President of Medicaid, emphasized the initiative's intent to alleviate the challenges posed by a cancer diagnosis. "By approving a broader set of treatments and related services upfront, we're removing barriers that can delay care," she stated. This change allows oncologists greater flexibility in treatment decisions and helps patients focus on their recovery and family during a difficult time.
Addressing the administrative burdens faced by healthcare providers was also a concern highlighted in Aetna's latest Provider Survey, in which 74% of respondents indicated that this was a key challenge. Furthermore, nearly one-third of providers identified prior authorization management as a major contributor to administrative burdens. Aetna anticipates that its new bundled approach will allow clinicians to save significant time on administrative tasks, with about 30% of surveyed providers believing they could save over an hour daily.
Looking ahead, Aetna plans to extend eligibility for these prior authorization bundles to Medicare and Commercial members in the first half of 2027. Providers in states such as Oklahoma, Illinois, Maryland, New Jersey, Virginia, Florida, Kentucky, and West Virginia will be able to utilize the Eviti portal for submitting prior authorizations.