Aetna expands bundled cancer prior authorizations to Medicaid

Aetna, a CVS Health (NYSE: CVS) company, expanded prior authorization bundles across all cancer types for members in eligible Medicaid states as of September 1, with plans to extend coverage across all lines of business in 2027, according to a company press release.

The program consolidates multiple prior authorization requests — previously averaging four separate submissions per cancer patient — into a single request submitted through one portal. The bundle covers medical oncology services, including chemotherapy and immunotherapy where appropriate, radiation oncology, and associated high-tech imaging such as MRI and CT scans.

Aetna said nearly 25% of eligible members have already received a bundled prior authorization since the initial rollout. The expansion currently applies to providers in Oklahoma, Illinois, Maryland, New Jersey, Virginia, Florida, Kentucky, and West Virginia that use the Eviti portal.

"A cancer diagnosis can be overwhelming for patients and families, and the care team should be focused on their patient, not paperwork," said Katerina Guerraz, Aetna Chief Operating Officer and President of Medicaid. "By approving a broader set of treatments and related services upfront, we're removing barriers that can delay care."

According to Aetna's own provider survey, 74% of providers identified administrative burden as the top challenge facing clinical staff, with 31% citing prior authorization management as the single largest contributor. Thirty percent of survey respondents said they could save more than an hour daily on administrative tasks through technology solutions such as bundles, while 80% expected to save more than 30 minutes.

Aetna said it plans to expand eligibility to Medicare and Commercial members in the first half of 2027.

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