Aetna Supports Industry Actions to Simplify Prior Authorization
- Company commits to distinctive actions that will make it easier to navigate the health care system, access care, and achieve better health
HARTFORD, Conn., June 23, 2025 /PRNewswire/ -- Aetna, a CVS Health company (NYSE:CVS), today announced its support of initiatives championed by American's Health Insurance Plans to improve the experience of doctors and patients. Aetna is also committed to leading the market through a comprehensive strategy to make it easier to navigate health care – reducing reviews, simplifying care site transitions, and putting technology to work for healthcare professionals and their patients.
"The American health care system must work better for people, and we will improve it in distinctive ways that truly matter," said Aetna president Steve Nelson. "We support the industry's commitments to streamline, simplify, and reduce prior authorization. We will go beyond prior authorization, building a health care experience for people we serve, and introducing solutions that improve navigation and advocacy for Aetna members."
Aetna already has one of the shortest lists of treatments and procedures requiring prior authorization in the industry. Of eligible prior authorizations, more than 95 percent are approved within 24 hours, with some completed in just a few hours.
Bundling Prior Authorizations
One area we can simplify is the prior authorization (PA) process. For people with lung, breast, or prostate cancer who need prior authorizations for MRI or CT scans, we are bundling multiple authorization requests into one up front approval.
Later this year, we plan to add additional bundles for cardiology and musculoskeletal conditions. This initial scope has the potential to help thousands of members across our Commercial and Medicare plans and the medical professionals caring for them.
Aetna Clinical Collaboration Program
We have also introduced our Aetna Clinical Collaboration (ACC) program, which focuses on improving care transitions for patients moving between care settings. In this program, our nurses work with other medical professionals to help members get to the most appropriate care setting when they leave the hospital. Our goal is to reduce 30-day readmission rates and emergency room visits, resulting in improved care outcomes and cost savings.
What makes this program unique is that Aetna nurses work on-site at health care facilities, collaborating directly with a patient's care team to coordinate a transition from the hospital to their home or other community care program based on the individual's health needs. By comprehensively supporting a person's health care touch points – medical, pharmacy, mental wellbeing, and other areas – there is a seamless transition to care at home or in a community setting with a proactive care plan in place.
We have successfully launched the ACC program providing support for Medicare Advantage members transitioning out of a hospital setting and reducing hospital readmissions. We expect to expand this program later this year to other facilities, and to commercial members, people under 65 who get their health benefits from their employer.
Technology Enhancements for Both Members and Healthcare Professionals
We are making significant advancements with our digital tools that help members navigate their health care and gain greater transparency. These enhancements focus on enabling real-time status updates if a prior authorization is required.
Recent updates to the Aetna Health app give Aetna members access to features like Smart Compare that helps match members with medical professionals who are suited to the member's health needs and budget. In addition, we provide status badges showing prior authorization progress, expanded information about service quantities (such as hospital stays and physical therapy visits), and clearer explanations of coverage decisions. These improvements allow members to better track their care journey and understand their authorization status without repeatedly contacting their providers for updates.
Aetna is leading the way in transforming the health care experience by reducing friction, partnering more closely with doctors and hospitals, and offering greater visibility. Through these initiatives, doctors can focus more on patient care and less on administrative tasks, while members benefit from clearer communication and simpler health care journeys.
About Aetna
Aetna, a CVS Health business, serves an estimated 36 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental and behavioral health plans, and medical management capabilities, Medicaid health care management services, workers' compensation administrative services and health information technology products and services. Aetna's customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care professionals, governmental units, government-sponsored plans, labor groups and expatriates. For more information, visit Aetna.com (e.g., clinical diagnoses, eligibility criteria, participation in a disease state management program).
About CVS Health
CVS Health is a leading health solutions company building a world of health around every consumer, wherever they are. As of March 31, 2025, the Company had more than 9,000 retail pharmacy locations, more than 1,000 walk-in and primary care medical clinics, a leading pharmacy benefits manager with approximately 88 million plan members, and a dedicated senior pharmacy care business serving more than 800,000 patients per year. The Company also serves an estimated more than 37 million people through traditional, voluntary and consumer-directed health insurance products and related services, including highly rated Medicare Advantage offerings and a leading standalone Medicare Part D prescription drug plan. The Company's integrated model uses personalized, technology driven services to connect people to simply better health, increasing access to quality care, delivering better outcomes, and lowering overall costs.
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SOURCE CVS Health