HARTFORD, Conn. — Aetna, a CVS Health company, announced Thursday new milestones today as part of its ongoing strategy to reduce friction in the health care system. These initiatives aim to improve the experience for both health care professionals and their patients by streamlining processes and enhancing support.
“Aetna committed to several bold actions earlier this year that were intended to improve the American healthcare industry and I’m proud of the progress we’ve made against these commitments,” said Aetna president Steve Nelson. “Working in partnership with stakeholders across the industry, I am optimistic that we can achieve our shared purpose of simplifying the healthcare system to make it easier for consumers to navigate and access affordable, personalized solutions.”
Removing friction by bundling prior authorization
While the prior authorization process has an important role to play in promoting quality care and managing health insurance coverage, Aetna remains focused on delivering clinical value while also reducing friction in the payer-provider experience. This is why we are leveraging our clinical, pharmaceutical and technological expertise to offer condition-specific, prior authorization bundles.
With these capabilities, Aetna is one of the first, large national healthcare payers to integrate pharmacy prescriptions and medical procedures into a single clinical review. Previously, providers had to submit two separate prior authorizations — one for medical procedures like in vitro fertilization (IVF) and one for related medications under the Aetna pharmacy plan. As of November 2025, providers simply file the medical PA, and if approved, the associated medications covered under the Aetna pharmacy benefit are automatically approved.
Additionally, effective November 2025, Aetna has rolled out a musculoskeletal offering that includes X-rays, knee arthroplasty (THA/TKA) surgical procedure, anti-nausea and non-opioid pain medications, inpatient admission if needed, infection control, and durable medical equipment. This builds on the momentum of lung, breast or prostate cancer prior authorization bundles earlier this year.
Delivering new care models with Aetna Clinical Collaboration (ACC)
Through our deep partnerships with providers and plan sponsors, Aetna can offer innovative care and benefit options that help patients gain access to personalized, affordable care. The ACC program brings Aetna nurses together with hospital staff, working side-by-side to help Medicare Advantage members get the care and support they need to remain healthy when they return home from the hospital or make the transition into a skilled nursing facility.
The program is projected to reduce year-over-year 30-day readmissions and hospital length of stay for members by five percent once fully implemented. ACC is already being rolled out in 17 hospitals and medical facilities with plans to continue expanding across Medicare and the Commercial business.
Helping members navigate using AI-enabled solutions
As part of CVS Health’s $20 billion multi-year digital investment, Aetna continues to create and integrate AI and digitally enabled solutions to help members navigate the healthcare system, moving from a transactional experience to an end-to-end offering.
The Aetna Health app has launched to an initial population a leading edge, conversational AI function that will be expanded in early 2026. Unlike other industry alternatives where conversational AI is relegated to a chat window, Aetna is embedding generative AI throughout its end-to-end digital experience. To see the full member experience, you can click here.
In addition to improving the member experience, Aetna continues to leverage technology innovations across its operational systems, including claims processing, client onboarding and care management to further simplify the healthcare system and become best-in-class for our customers, members and providers.
