WOONSOCKET, R.I. – Aetna is expanding its bundled oncology prior authorization program across all cancer types for members in eligible Medicaid states, aiming to reduce administrative burden for providers and accelerate access to cancer care.
The CVS Health company said the expansion, effective Sept. 1, builds on its initial rollout, with nearly 25% of eligible members receiving a bundled prior authorization.
Aetna said providers had been submitting an average of four separate prior authorizations for each member requiring cancer treatment. The bundled approach allows providers to submit a single prior authorization covering multiple services through one portal.
The bundles can combine medical oncology services, including chemotherapy and immunotherapy when appropriate, and radiation oncology services with related high-tech imaging such as MRI and CT scans.
“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. Oncologists have the flexibility to make care decisions as treatment plans evolve, and individuals can focus on what matters most: their health, recovery, and time with their loved ones.”
Aetna cited administrative burden as a continuing challenge for providers. In its latest provider survey, 74% of respondents identified administrative burden as the top challenge facing clinical staff, while 31% identified prior authorization management as its largest contributor.
The insurer plans to expand eligibility for bundled oncology prior authorizations to Medicare and commercial members in the first half of 2027.
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