Aetna expands initiatives to simplify experiences for health care professionals and patients

Rhea-AI Summary

Aetna (NYSE: CVS) announced December 4, 2025 updates that simplify prior authorization, expand clinical collaboration, and add AI capabilities to the Aetna Health app.

Key actions: effective November 2025 Aetna now bundles medical and pharmacy prior authorizations for certain conditions (examples: IVF, musculoskeletal bundles including X-rays, THA/TKA, specified meds and DME). The Aetna Clinical Collaboration (ACC) program is live in 17 hospitals and is projected to reduce 30-day readmissions and length of stay by 5% when fully implemented. As part of CVS Health's $20 billion multi-year digital investment, generative AI features have launched to an initial population and will expand in early 2026.

Positive

• Prior authorization bundles integrate pharmacy and medical PA as of Nov 2025
• Musculoskeletal bundle live Nov 2025: X-rays, THA/TKA, meds, inpatient and DME
• ACC program projected to cut 30-day readmissions and LOS by 5%
• $20 billion multi-year digital investment backing AI and app rollout

Negative

• ACC currently deployed in only 17 hospitals as of Dec 4, 2025

Insights

Healthcare operations analyst

Aetna's bundled prior authorizations and embedded generative AI signal operational simplification with measurable care coordination goals.

The move to combine medical and pharmacy prior authorizations for condition-specific bundles removes a documented administrative step by letting providers file one medical PA that, if approved, auto-approves related pharmacy medications; this change began in November 2025. The rollout of a musculoskeletal bundle and prior bundles for lung, breast, and prostate cancer imply a repeatable process for linking procedures, drugs, inpatient services, and durable medical equipment under a single clinical review.

Program success depends on integration of clinical, pharmacy, and claims systems and on provider adoption; the brief cites a projected 5% year-over-year reduction in 30-day readmissions and length of stay for the Aetna Clinical Collaboration program once fully implemented, which is a concrete operational metric to track. The Aetna Health app's expansion of generative AI began for an initial population and is slated to expand in early 2026, backed by CVS Health's $20 billion digital investment, indicating sustained funding but requiring monitoring of rollout scope, accuracy, and member uptake.

Watch adoption and measurable outcomes over the next 6–18 months: verify whether the bundled PA workflow reduces total authorization turnaround time and administrative charges, confirm the actual readmission and length-of-stay changes versus the stated 5% target, and track the Aetna Health app's AI feature expansion performance after early 2026. These items provide observable signals of operational impact without assuming financial or clinical efficacy beyond the disclosed claims.

• Bundling medical procedures and pharmaceutical medications into one prior authorization
• Implementing end-to-end generative AI capabilities into Aetna Health app

HARTFORD, Conn., Dec. 4, 2025 /PRNewswire/ -- Aetna^®, a CVS Health^® company (NYSE: CVS), today announces key milestones in support of the company's comprehensive strategy announced in June to remove friction in the healthcare system and improve the experience for healthcare professionals and their patients.

"Aetna committed to several bold actions earlier this year that were intended to improve the American healthcare industry and I'm proud of the progress we've made against these commitments," said Aetna president Steve Nelson.  "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 and access affordable, personalized solutions."

Removing friction by bundling prior authorization
While the prior authorization process has an important role to play in promoting quality care and managing health insurance coverage, Aetna remains focused on delivering clinical value while also reducing friction in the payer-provider experience. This is why we are leveraging our clinical, pharmaceutical and technological expertise to offer condition-specific, prior authorization bundles. 

With these capabilities, Aetna is one of the first, large national healthcare payers to integrate pharmacy prescriptions and medical procedures into a single clinical review. Previously, providers had to submit two separate prior authorizations — one for medical procedures like in vitro fertilization (IVF) and one for related medications under the Aetna pharmacy plan.  As of November 2025, providers simply file the medical PA, and if approved, the associated medications covered under the Aetna pharmacy benefit are automatically approved.

Additionally, effective November 2025, Aetna has rolled out a musculoskeletal offering that includes X-rays, knee arthroplasty (THA/TKA) surgical procedure, anti-nausea and non-opioid pain medications, inpatient admission if needed, infection control, and durable medical equipment.  This builds on the momentum of lung, breast or prostate cancer prior authorization bundles earlier this year.

Delivering new care models with Aetna Clinical Collaboration (ACC) 
Through our deep partnerships with providers and plan sponsors, Aetna can offer innovative care and benefit options that help patients gain access to personalized, affordable care.  The ACC program brings Aetna nurses together with hospital staff, working side-by-side to help Medicare Advantage members get the care and support they need to remain healthy when they return home from the hospital or make the transition into a skilled nursing facility.  

The program is projected to reduce year-over-year 30-day readmissions and hospital length of stay for members by five percent once fully implemented.  ACC is already being rolled out in 17 hospitals and medical facilities with plans to continue expanding across Medicare and the Commercial business.

Helping members navigate using AI-enabled solutions
As part of CVS Health's $20 billion multi-year digital investment, Aetna continues to create and integrate AI and digitally enabled solutions to help members navigate the healthcare system, moving from a transactional experience to an end-to-end offering.  

The Aetna Health app has launched to an initial population a leading edge, conversational AI function that will be expanded in early 2026. Unlike other industry alternatives where conversational AI is relegated to a chat window, Aetna is embedding generative AI throughout its end-to-end digital experience. To see the full member experience, you can click here.

In addition to improving the member experience, Aetna continues to leverage technology innovations across its operational systems, including claims processing, client onboarding and care management to further simplify the healthcare system and become best-in-class for our customers, members and providers.

About Aetna

Aetna, a CVS Health business, serves an estimated 37 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental and behavioral health plans, and medical management capabilities, Medicaid health care management services, workers' compensation administrative services and health information technology products and services. Aetna's customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care professionals, governmental units, government-sponsored plans, labor groups and expatriates. For more information, visit Aetna.com (e.g., clinical diagnoses, eligibility criteria, participation in a disease state management program).

About CVS Health
CVS Health is a leading health solutions company building a world of health around every consumer, wherever they are. As of September 30, 2025, the Company had approximately 9,000 retail pharmacy locations, more than 1,000 walk-in and primary care medical clinics and a leading pharmacy benefits manager with approximately 87 million plan members. The Company also serves an estimated more than 37 million people through traditional, voluntary and consumer-directed health insurance products and related services, including highly rated Medicare Advantage offerings and a leading standalone Medicare Part D prescription drug plan. The Company's integrated model uses personalized, technology driven services to connect people to simply better health, increasing access to quality care, delivering better outcomes, and lowering overall costs.

Media contact
Phil Blando
Phillip.Blando@CVSHealth.com 

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SOURCE CVS Health

FAQ

What change did Aetna announce about prior authorization on Dec 4, 2025 for CVS (NYSE: CVS)?

Aetna said that, effective November 2025, certain condition-specific prior authorizations now bundle medical procedures and pharmacy so associated medications auto-approve if the medical PA is approved.

Which procedures are included in Aetna's November 2025 musculoskeletal bundle?

The musculoskeletal bundle includes X-rays, knee/hip arthroplasty (THA/TKA), anti-nausea and non-opioid pain meds, inpatient admission if needed, infection control, and durable medical equipment.

How will Aetna Clinical Collaboration (ACC) affect hospital readmissions for CVS members?

Aetna projects ACC will reduce year-over-year 30-day readmissions and hospital length of stay by 5% once fully implemented.

What AI features did Aetna launch in the Aetna Health app and when will they expand?

Aetna launched an embedded generative conversational AI to an initial population and plans to expand the feature in early 2026 as part of the app experience.

How much digital investment supports Aetna's AI and app plans under CVS Health?

Aetna's digital and AI work is part of CVS Health's announced $20 billion multi-year digital investment.