Admin_Adham
Jump to Key Points NEW YORK, Sept 17 (Reuters) - CVS Health's Aetna health insurance unit will cut back next year on the preapprovals it requires for treatment for cancer patients to only one medical prior authorization process early on, the company said on Thursday.
Providers will get the insurer's go-ahead for care by submitting documentation showing a patient is receiving treatment for cancer rather than submitting separate approvals for its various components such as chemotherapy, radiation treatment, imaging and some immunotherapies.
The company said it would roll out the bundled process in the first half of 2027 for all of its private plans as well as its Medicare Advantage plans for adults aged 65 and older and people with disabilities. The changes began for Medicaid members in eight states on September 1.
Katerina Guerraz, chief operating officer at Aetna, said: "Cancer prevalence is high, and unfortunately it continues to increase."
- Aetna to require 1 early cancer prior auth for bundled care.
- Bundled approval covers chemo, radiation, imaging, some immunotherapies.
- Rollout: Medicaid in 8 states already; private + Medicare Advantage in 2027.
- Cancer members average 4 prior auths/course at Aetna.
- Aetna may extend streamlined auth model to musculoskeletal care.
Guerraz said Aetna's reduction focuses on oncology because the treatments rely heavily on repeated radiology scans, such as MRI or CT imaging, which are subject to such authorizations from most insurers.
Through the course of treatment, providers submit four prior authorizations on average for each Aetna member with cancer, CVS said in a statement. Aetna plans to scale the model in the future for people with musculoskeletal conditions, such as knee and hip problems, Guerraz said.
CVS Health operates health insurer Aetna, a retail pharmacy chain and a pharmacy benefit manager, Caremark.
A survey sponsored by CVS showed 74% of providers identified administrative burden as a top challenge for clinicians, with 31% citing prior authorizations as the largest factor.
AHIP, an insurance industry trade group, in 2025 led industry-wide commitments to reduce the number of medical services requiring approval, standardize electronic submissions across insurers and speed up responses.
Rival UnitedHealthcare, part of UnitedHealth Group, has said it will eliminate about 30% of its prior authorization requirements across its insurance business, while Humana has pledged to eliminate 33% of prior authorizations for outpatient services.
Providers can submit the approvals to Aetna through one online portal, Guerraz said, reducing time spent on approvals for providers and boosting response times.
(Reporting by Amina Niasse; Editing by Jamie Freed)
