The Investor
17 Sep 2026, 16:13
CVS Health’s Aetna Expands Bundled Cancer Prior Authorizations
CVS Health’s Aetna is expanding bundled prior authorizations across all cancer types for eligible Medicaid members, with plans to extend the model across all lines of business in 2027.
The approach allows providers to submit a single prior authorization covering multiple related cancer services, including chemotherapy, immunotherapy, radiation oncology and associated imaging such as MRI and CT scans. Aetna said providers had previously submitted an average of four separate prior authorization requests for each member undergoing cancer treatment.
Aetna said nearly 25% of eligible members are already receiving bundled prior authorizations following the initial rollout. The company expects the expanded process to reduce administrative work and speed patient access to approved treatment services.
The insurer cited provider survey data showing that 74% of respondents viewed administrative burden as their biggest clinical challenge, while 31% identified prior authorization management as the single largest contributor.
Aetna plans to expand eligibility to Medicare and commercial members in the first half of 2027, broadening the program beyond Medicaid.
CVS Health’s Aetna is expanding bundled prior authorizations across all cancer types for eligible Medicaid members, with plans to extend the model across all lines of business in 2027.
The approach allows providers to submit a single prior authorization covering multiple related cancer services, including chemotherapy, immunotherapy, radiation oncology and associated imaging such as MRI and CT scans. Aetna said providers had previously submitted an average of four separate prior authorization requests for each member undergoing cancer treatment.
Aetna said nearly 25% of eligible members are already receiving bundled prior authorizations following the initial rollout. The company expects the expanded process to reduce administrative work and speed patient access to approved treatment services.
The insurer cited provider survey data showing that 74% of respondents viewed administrative burden as their biggest clinical challenge, while 31% identified prior authorization management as the single largest contributor.
Aetna plans to expand eligibility to Medicare and commercial members in the first half of 2027, broadening the program beyond Medicaid.
