Aetna is expanding bundled prior authorizations across all types of cancer for enrollees in its Medicaid plans across eight states.
The latest expansion took effect on Sept. 1, the company said in an announcement, and the insurer expects to roll the program out to all of its lines of business next year. Eligibility is expected to extend to Medicare and commercial plans in the first half of 2027.
Aetna said that it recognized providers were submitting multiple prior authorizations for patients in need of cancer treatment. By bundling those decisions together in a single prior authorization request, it simplifies the patients' journey and reduces delays. The bundles include medical oncology services, such as chemotherapy or immunotherapy, with radiation oncology services like imaging into one request.
In the program's initial rollout, about 25% of members were eligible for bundled prior authorizations, Aetna said.
"A cancer diagnosis can be overwhelming for patients and families, and the care team should be focused on their patient, not paperwork," said Katerina Guerraz, Aetna chief operating officer and president of Medicaid, in the press release.
"By approving a broader set of treatments and related services upfront, we're removing barriers that can delay care," Guerraz continued. "Oncologists have the flexibility to make care decisions as treatment plans evolve, and individuals can focus on what matters most: their health, recovery and time with their loved ones."
In addition to smoothing out the patient experience, reducing the number of prior authorization submissions can also ease provider burdens, Aetna said. In a July survey, Aetna found that 74% of providers named administrative burden as the top challenge facing clinical staff, with 31% saying prior auth is the single largest factor increasing that burden.