Holding to a health insurance industry commitment to reduce the need for prior authorization, CVS Health’s Aetna health insurance unit said Thursday it will “integrate pharmacy prescriptions and medical procedures into a single clinical review.” Aetna’s CEO Steve Nelson is speaking about some of the health insurer’s business practices centered around improving patient experience at the Forbes Healthcare Summit December 4, 2025 in New York. In this photo, Snow covers the ground around Aetna Inc. signage displayed outside of the company’s corporate headquarters in Hartford, Connecticut, U.S., on Friday, Feb. 6, 2015. (Photographer: Ron Antonelli/Bloomberg)
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Holding to a health insurance industry commitment to reduce the need for prior authorization, CVS Health’s Aetna health insurance unit said it will “integrate pharmacy prescriptions and medical procedures into a single clinical review.”
The health insurer’s president Steve Nelson, who will speak Thursday afternoon at the annual Forbes Healthcare Summit, will outline an array of business industry practices that are changing for the nation’s third-largest health insurer to improve health outcomes and the patient experience.
“We’re moving away from a transactional mindset to a consumer-driven solutions mindset,” Nelson said in an interview ahead of the summit.
Part of the Aetna effort involves “bundling prior authorizations” within the health plan enrollee’s medical benefit, so they only need a single prior authorization once diagnosed with a specific condition.
“Aetna committed to several bold actions earlier this year intended to improve the American healthcare industry and I’m proud of the progress we’ve made against these commitmemts,” Nelson said in a statement outlining some of Aetna’s new business practices centered around patient experience. “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 healthcare and access affordable, personalized solutions.”
Earlier this year, Aetna was among the biggest names in health insurance, including Cigna, UnitedHealth Group’s UnitedHealthcare and Humana and more than 50 health insurers that committed to “streamline, simplify and reduce” prior authorization, the process of insurers reviewing hospital admissions and medications.
The sweeping commitments were announced this past summer by America’s Health Insurance Plans, also known as AHIP, and the Blue Cross Blue Shield Association, which have health plan members that provide health benefits to more than 250 million Americans. They said they “aim to accelerate decision timelines, increase transparency and expand access to affordable, quality care.”
Doctors complain prior authorization has delayed needed treatment and put patient health in jeopardy while wasting physician and patient time to jump through hoops. Over the past several years, prior authorization increasingly has become a concern for patient access to needed services, according to almost 30% of physicians responding to an American Medical Association survey in 2023.
In Aetna’s case, the health insurance giant Thursday said its first bundling approach across the medical and pharmacy benefit will be for women seeking in vitro fertilization (IVF) and will eventually be rolled out to more conditions and diseases. “Providers simply file the medical PA, and if approved, the associated medications covered under the Aetna pharmacy benefit are automatically approved,” Aetna said in a statement announcing the new approach to prior authorization.
Source: https://www.forbes.com/sites/brucejapsen/2025/12/04/cvs-aetna-to-meld-drug-and-medical-approvals-as-insurers-cut-hurdles/
