Aetna is rolling out new initiatives aimed at reducing administrative burden for providers by bundling pharmacy prescriptions and medical procedures into a single clinical review, according to a Dec. 4 announcement. Previously, providers were required to submit separate prior authorizations for medical services and related medications. As of November, providers now submit one medical review, with associated medications covered under the Aetna pharmacy benefit automatically approved.
As part of this effort, Aetna also introduced a musculoskeletal prior authorization bundle. The bundle includes services and supplies commonly associated with orthopedic care, such as X-rays, knee arthroplasty procedures, nonopioid pain and antinausea medications, inpatient admissions, infection prevention measures, and related medical equipment.
The changes reflect Aetna’s broader strategy to simplify healthcare experiences for both providers and patients. Company leadership emphasized collaboration across the healthcare industry to streamline processes and improve access to more affordable, personalized care.
These efforts build on earlier commitments by Aetna and other insurers to modernize and automate prior authorization workflows, an initiative highlighted by The Wall Street Journal in 2023. In addition, Aetna is piloting a conversational AI feature within the Aetna Health app to help members navigate benefits and care more easily, with broader availability expected in early 2026.
Resources: Aetna merges prescriptions, procedures into single prior authorization
Aetna expands initiatives to simplify experiences for health care professionals and patients