Aetna offers providers prior authorization bundles for specific conditions
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Aetna offers providers prior authorization bundles for specific conditions Once the medical prior authorization is approved, the associated medications will be automatically approved.
Claims Processing By Susan Morse , Executive Editor | December 8, 2025 | 10:15 AM Photo: Diego Cervo/Getty Images Aetna has announced it is integrating pharmacy prescriptions and medical procedures into a single clinical review to streamline the prior authorization process.The prior authorization bundles are for condition-specific procedures, Aetna said. Previously, providers had to submit two separate prior authorizations, such as one for medical procedures such as vitro fertilization (IVF) and one for related medications under the Aetna pharmacy plan. As of November 2025, providers may file the medical prior authorization and, if approved, the associated medications covered under the Aetna pharmacy benefit will be automatically approved.Aetna said it is one of the first, large national healthcare payers to integrate pharmacy prescriptions and medical procedures into a single clinical review.WHY THIS MATTERSAetna, which is part of CVS Health, said it is leveraging its clinical, pharmaceutical and technological expertise to support the company’s strategy announced in June to remove friction in the healthcare system, specifically the payer-provider experience. Aetna said the prior authorization process has an important role to play in promoting quality care and managing health insurance coverage.“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.”THE LARGER TRENDAlso in November 2025, Aetna 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.Aetna Clinical Collaboration brings Aetna nurses together with hospital staff, working to help Medicare Advantage members get the care and support they need when they return home from the hospital or in making the transition to a skilled nursing facility. The program is projected to reduce year-over-year 30-day readmissions and hospital length of stay for members by 5% once fully implemented, Aetna said. ACC has been rolled out in 17 hospitals and medical facilities with plans to continue expanding across Medicare and the commercial business.CVS Health’s $20 billion multi-year digital investment, creates and integrates AI and digitally enabled solutions to help members navigate the healthcare system.
The Aetna Health app has launched a conversational AI function that will be expanded in early 2026. Unlike other apps in which conversational AI is relegated to a chat window, Aetna said it is embedding generative AI throughout its end-to-end digital experience. Email the writer: [email protected] Topic: Artificial Intelligence, Claims Processing, Digital Health, Operations, Pharmacy, Reimbursement, Revenue Cycle Management, Strategic Planning