Aetna bundles cancer treatment prior authorizations following industrywide scrutiny

CVS’s health insurance arm, Aetna, is expanding bundled prior authorizations (PAs) to all cancer treatments in a move that builds on an industrywide effort to streamline and reduce PAs following years of criticism from patients and government pressure.

Submitting PA requests takes up a significant chunk of physicians’ time and effort. Survey data from the American Medical Association found that in 2024, practices completed an average of 40 PAs per physician weekly. That amounted to an average of 13 hours of work per week. A vast majority (94%) of physicians said the PA process increases burnout, which is driving doctors to leave medicine, contributing to the nationwide doctor shortage.

Prior authorizations can be time-consuming because they are often completed via phone or fax and require multiple steps, such as a peer-to-peer review. That’s when a physician is required to talk to a clinician who works for the insurance company to discuss why a treatment is medically necessary.

In cancer care, PAs are “a huge issue,” Joanna Yang, chair of the government relations committee for the professional group the American Society of Clinical Oncology (ASCO), told Healthcare Brew. 

Getting a treatment approved “can take a really long time, and so during that time, some cancers are rapidly growing,” Yang said. “You [as a patient] could be at a more advanced stage. You could be at a point where the curative treatment that you were going to get is no longer an option for you.”

In a 2024 survey, ASCO reported 30% of 736 radiation oncologists said PA requirements had caused serious complications for patients, and 7% reported that they had contributed to a patient’s death.

The details. Aetna announced in September that it would expand a program to allow bundled PA requests for all cancer care, meaning physicians would submit a single request for multiple treatments rather than one for each individual treatment. The insurer initially piloted the program in 2025 for breast, lung, and prostate cancer treatments. Roughly 25% of eligible members received a bundled PA, the company said in a September 2026 press release.

“Because we bundle all of it up front…as the patient’s going through that course of treatment, if one day or that week that doctor says, ‘You know what? I think you need immunotherapy,’ they have the flexibility,” Katerina Guerraz, COO of Aetna, told Healthcare Brew. “They’re not waiting for an approval—they know it’s already approved if the patient needs it.”

Oncologists can now submit bundled PAs for treatment for all types of cancers. The bundles include medical oncology services like chemotherapy and immunotherapy as well as radiation oncology services and related imaging, such as MRI or CT scans.

The Aetna program is currently only available for Medicaid patients in eight states: Maryland, New Jersey, Florida, West Virginia, Oklahoma, Kentucky, Illinois, and Virginia. Aetna, which has a total of 26 million members receiving medical benefits (with 2.3 million on Medicaid), plans to make bundling available for the treatment of Medicare and commercial members in the first half of 2027.

Remedying the larger issue. Yang suggested several steps the insurance industry could take to make the PA process more efficient.

For instance, if the treatment or service a provider prescribes fits within guidelines set by the National Comprehensive Cancer Network—an alliance of cancer centers that sets evidence-based standards for cancer care—it shouldn’t have to go through the PA process, she said.

There should also be a tracker that both providers and patients can access to check the status of a PA request, she added. Additionally, “there should be consequences when these [steps] aren’t followed and there are negative outcomes.”

Chris Bond, a spokesperson for AHIP, the health insurance industry’s largest trade group, said in a statement shared with Healthcare Brew that “health plans [are] working to protect patients with safe, evidence-based, coordinated care.”

“Health plans’ multiyear commitments are streamlining prior authorization, and as more providers do away with error-prone manual processes and adopt electronic prior authorization, health plans’ standardized approach will mean faster answers and less friction for everyone,” he continued.

AHIP said in a press release last June that prior authorizations are “a critical safeguard to ensure their members’ care is safe, effective, evidence-based, and affordable.” The agency also said in an April 2026 release that large insurers have done away with 11% of PAs industrywide, as part of a broader industrywide effort to streamline them.

Healthcare Brew also reached out to the American Medical Association but did not hear back by publication.