Aetna Expands Bundled Oncology Prior Authorizations to Reduce Administrative Burden and Accelerate Access to Cancer Care
Aetna®, a CVS Health® company, is expanding its bundled prior authorization program for oncology services to cover all types of cancer for eligible Medicaid members across participating states. Effective September 1, the expanded program is designed to simplify the authorization process for providers, reduce administrative work associated with cancer treatment and help members gain faster access to approved care.
The expansion represents a significant development in Aetna’s efforts to streamline healthcare administration through technology and more coordinated authorization processes. Following the initial rollout of bundled oncology prior authorizations, the company reported that nearly 25% of eligible members received a bundled prior authorization. Under the approach, multiple services associated with a member’s cancer treatment can be reviewed and approved through a single authorization rather than requiring providers to submit several separate requests.
Aetna also plans to extend bundled oncology prior authorizations across all lines of business in 2027. The broader rollout would build on the experience gained through the Medicaid program and expand the approach to additional members and healthcare providers.
Simplifying the Prior Authorization Process for Cancer Treatment
Prior authorization is commonly used by health plans to review whether certain healthcare services meet coverage and clinical criteria before those services are provided. While the process can help coordinate care and manage utilization, submitting multiple authorization requests for a single treatment journey can create substantial administrative work for healthcare providers.
Cancer treatment can involve a series of interconnected services delivered over an extended period. Depending on the diagnosis and treatment plan, a patient may receive chemotherapy, immunotherapy, radiation therapy, advanced imaging and other oncology-related services.
Aetna said providers were submitting an average of four separate prior authorization requests for each member requiring cancer treatment. Each request can involve additional administrative steps, documentation and communication between providers and health plans.
The bundled approach is intended to consolidate these requirements. Instead of submitting multiple authorization requests separately, providers can request approval for a broader package of cancer-related services through one secure process.
The bundles can include medical oncology services, such as chemotherapy and immunotherapy when appropriate, and radiation oncology services. They can also incorporate associated high-tech imaging services, including magnetic resonance imaging (MRI) and computed tomography (CT) scans.
By combining related services into a single request, the program is intended to give providers greater clarity about which components of a treatment plan have been authorized before care begins.
Supporting Patients Throughout Their Treatment Journey
For individuals diagnosed with cancer, treatment frequently involves multiple appointments, procedures, medications and diagnostic tests. Coordinating these services can already be challenging for patients and their families, particularly when treatment plans change as clinicians evaluate how a patient responds.
Aetna’s bundled authorization model is intended to address part of the administrative complexity surrounding that process.
Katerina Guerraz, Aetna Chief Operating Officer and President of Medicaid, said cancer diagnoses can be overwhelming for patients and families and that healthcare teams should be able to prioritize their patients rather than paperwork.
According to Guerraz, providing approval for a broader set of treatments and related services upfront can help reduce barriers that may otherwise contribute to delays. The approach is also designed to give oncologists flexibility as treatment plans evolve.
This flexibility is important because cancer care is not always delivered according to a fixed sequence. Physicians may adjust treatment based on clinical findings, diagnostic results and the patient’s response to therapy. A broader authorization framework can potentially reduce the need for providers to repeatedly initiate administrative processes when treatment plans change within the scope of the approved services.
The objective is not to replace clinical decision-making but to make the administrative process surrounding authorized services more efficient.
Addressing Provider Administrative Burden
Administrative workload continues to be an important issue for healthcare organizations. Physicians, nurses and other clinical staff frequently spend time completing forms, submitting documentation, tracking authorization decisions and communicating with payers.
Aetna’s own provider research highlights the scale of the challenge. According to the latest Aetna Provider Survey, 74% of providers identified administrative burden as the top challenge facing clinical staff. Nearly one-third, or 31%, identified prior authorization management as the single largest contributor to that burden.
These findings demonstrate why changes to authorization workflows can have implications beyond individual administrative processes. Time spent managing authorizations is time that clinical staff may otherwise spend interacting with patients, coordinating treatment or performing other activities directly connected to care delivery.
Technology-based solutions, including automated workflows and bundled authorization models, are increasingly being explored as ways to reduce repetitive administrative tasks.
For oncology providers, where treatment can involve multiple services and specialists, reducing the number of authorization requests could simplify communication between clinical practices and health plans.
Potential Time Savings for Healthcare Providers
Aetna’s provider survey also examined how technology could affect the amount of time clinical staff spend on administrative work.
According to the survey, 30% of respondents believed they could save more than one hour per day through technology solutions such as bundled authorization processes. Meanwhile, 80% expected to save more than 30 minutes each day on administrative tasks.
Although these figures reflect providers’ expectations rather than a measurement of savings generated exclusively by Aetna’s oncology bundles, they illustrate the potential value of reducing repetitive administrative activities.
Even relatively small reductions in administrative work can become meaningful when multiplied across healthcare practices and treatment episodes. For a large oncology practice managing numerous patients, reducing multiple authorization submissions to a single bundled request could decrease the amount of time spent preparing and monitoring paperwork.
The impact could also extend to staff responsible for revenue cycle management, utilization management and patient scheduling, depending on how individual practices organize their authorization workflows.
Combining Oncology Services Through a Single Portal
One of the key features of Aetna’s program is the use of a single secure portal for submitting the bundled authorization request.
Under the expanded model, providers can submit requests that encompass multiple cancer-related services rather than initiating separate authorization processes for each component.
The bundled authorization may include medical oncology treatments such as chemotherapy and immunotherapy, where applicable. Radiation oncology services can also be included, along with related high-tech imaging such as MRI and CT scans.
This model reflects an effort to better align the administrative process with how cancer care is actually delivered. Rather than treating each service as an isolated authorization event, the bundle connects services that may form part of the same treatment journey.
For providers, this could mean fewer individual submissions and less need to track separate authorization statuses. For patients, the intended benefit is a more coordinated process surrounding the services included in their treatment plan.
Expansion Across Eligible Medicaid States
The latest expansion took effect September 1 and applies to eligible members in Medicaid states participating in the program. Aetna said the expanded program now covers all cancer types within the applicable Medicaid population.
The company previously launched bundled oncology prior authorizations on a more limited basis. The early results provided a foundation for the broader expansion.
Nearly one-quarter of eligible members—almost 25%—received a bundled prior authorization during the initial rollout. Aetna is using this experience as it expands the model to additional cancer types and prepares for a wider implementation.
The Medicaid expansion is also part of a longer-term strategy. Aetna plans to extend bundled oncology prior authorizations across all lines of business in 2027, potentially bringing the approach to a substantially larger member population.
The planned expansion demonstrates the company’s intention to use the bundled model as a broader administrative strategy rather than limiting it to a specific Medicaid program.
Implications for the Healthcare Industry
The move comes amid broader efforts across the healthcare industry to modernize prior authorization. Health plans, healthcare providers and technology companies have increasingly focused on reducing administrative friction while maintaining appropriate utilization management.
Prior authorization can serve an important role in healthcare coverage by establishing whether certain services meet applicable requirements before they are delivered. However, the number of individual requests required for complex treatment can create additional workload for providers.
Bundling offers one approach to addressing that issue. Instead of removing authorization requirements entirely, the process can consolidate related services into a single request.
For oncology, this approach may be particularly relevant because treatment often involves multiple services connected to a common diagnosis and care plan.
The broader industry shift toward digital healthcare administration also creates opportunities to integrate authorization workflows with electronic systems used by providers. Secure portals, digital documentation and technology-enabled communication can potentially reduce manual processes and improve visibility into authorization status.
A Focus on the Patient and Clinical Care Team
At the center of Aetna’s initiative is the goal of reducing administrative obstacles surrounding cancer treatment.
Cancer care requires substantial coordination among oncologists, radiologists, radiation specialists, nurses, diagnostic providers and other members of the healthcare team. Administrative processes are necessary, but excessive duplication can add complexity to an already demanding treatment environment.
By combining multiple services within a single prior authorization, Aetna is seeking to create a process that is more closely aligned with the overall treatment plan.
The company’s expansion also highlights the growing importance of administrative technology in healthcare. Digital solutions are increasingly being used not only for clinical applications but also for improving interactions between healthcare providers and insurers.
If bundled authorization models can reduce repetitive work while maintaining appropriate clinical review, they could become an increasingly important component of payer-provider collaboration.
Looking Ahead to 2027
Aetna’s planned expansion across all lines of business in 2027 will be the next major stage of the program. The company’s experience with eligible Medicaid members will provide an opportunity to evaluate the operational impact of bundled oncology authorizations as the model reaches additional populations.
The broader implementation could also provide further insight into how bundled authorization affects provider workflows, authorization volumes and the time required to manage administrative tasks.
For healthcare providers, the central objective is straightforward: reduce the amount of time spent navigating multiple authorization requests so clinical teams can devote more attention to patient care.
For patients and families dealing with cancer, the intended benefit is a more streamlined administrative pathway surrounding treatment. While prior authorization remains part of the healthcare coverage process, combining related services into a single request may help reduce unnecessary repetition.
Aetna’s expansion therefore represents another step toward simplifying healthcare administration through digital and bundled workflows. By extending oncology bundles to all cancer types within eligible Medicaid states and planning a broader rollout across its lines of business in 2027, the company is positioning the initiative as part of a longer-term effort to make cancer care administration more efficient.
As healthcare organizations continue to seek ways to address administrative burden, initiatives that connect multiple services into coordinated digital workflows could play an increasingly important role. Aetna’s oncology prior authorization expansion illustrates how payer technology and process redesign can be applied to a complex area of care, with the stated aim of reducing paperwork, supporting providers and helping members navigate their treatment journeys more efficiently.
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