Aetna Commits to New Initiatives to Streamline Prior Authorization

Aetna, a CVS Health company, has announced a series of initiatives aimed at reducing administrative burdens, improving care transitions, and enhancing transparency for members and providers. These efforts support broader industry goals while introducing new tools and programs that go beyond current standards.

The announcement followed an industry-wide meeting between leaders from the US Department of Health and Human Services and the Centers for Medicare & Medicaid Services on June 23, inviting health insurance companies and health systems to commit to improving prior authorization (PA) practices in the US. 

“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 in a press release. “We support the industry’s commitments to streamline, simplify and reduce prior authorization.”

Aetna is bundling PAs for members with lung, breast, or prostate cancer, enabling a single upfront approval for magnetic resonance imaging (MRI) or computed tomography (CT) scans. New bundles for cardiology and musculoskeletal conditions are expected later this year.

The Aetna Clinical Collaboration (ACC) program focuses on care transitions for Medicare Advantage members. As part of this initiative, Aetna nurses are placed on-site in hospitals to work directly with care teams, ensuring appropriate discharge planning and reducing 30-day readmission rates. The program will expand to commercial members and additional facilities in the coming months.

Digital enhancements to the Aetna Health app support real-time PA status updates and features like Smart Compare to match members with providers based on cost and care needs. Members can view PA progress, service quantity details, and clearer coverage explanations.

Aetna reports that more than 95% of eligible PAs are approved within 24 hours. These initiatives aim to simplify navigation for members and reduce workload for clinicians. By integrating care coordination, bundling authorizations, and advancing digital tools, Aetna is restructuring administrative processes to prioritize clinical outcomes and user experience. These steps reflect a broader strategy to modernize the health care journey across commercial and Medicare populations.

Reference
Aetna supports industry actions to simplify prior authorization. Press release. CVS Health. Published on June 23, 2025. Accessed June 26, 2025. https://www.cvshealth.com/news/company-news/aetna-supports-industry-actions-to-simplify-prior-authorization.html