PR Newswire
HARTFORD, Conn., Jan. 22, 2026 /PRNewswire/ — CVS Health® today announced key milestones in its ongoing effort to make health care simpler and more affordable for American consumers.
“Our ambition is to be America’s most trusted health care company,” said David Joyner, President and CEO of CVS Health. “We are partnering with the Administration and Congress to deliver common-sense solutions that make health care more affordable and improve outcomes for the people we serve. We continue to decrease prior authorizations, reduce hospital readmissions and emergency room visits, and bring down the costs of prescription drugs. The underlying costs of health care — primarily hospitals and new pharmaceuticals — continue to push up insurance premiums in the United States. We welcome policymakers’ assistance in driving out provider fraud and combatting drugmaker price gouging.”
Simplification
Part of CVS Health, Aetna® continues to make good on significant commitments to remove friction in the health care system and improve the experience for health care professionals and their patients. The prior authorization process has been hindered by incomplete data provided by clinicians, as well as the lack of technology interoperability across the health care system, but we have made significant strides in making the process simpler.
- Across the insurance industry, Aetna has the fewest medical services subject to prior authorization — about half as many as our nearest competitor. We approve more than 95% of all eligible prior authorizations within 24 hours, with many completed instantaneously. We currently approve 77% of electronic prior authorizations in real-time, and we will exceed 80% by the end of this year.
- We have met our commitments to enhance cross-payer interoperability to ensure continuity of care when patients switch health plans. By the end of this year, the 5-10 prior authorizations that represent 40% of the volume will adhere to consistent cross-payer clinical and technology standards. Furthermore, we are expanding this alignment effort to 50 of the most common prior authorization procedures in Medicare.
- Last year, we began bundling prior authorizations for certain conditions into a single request that would provide approval for a series of future tests and interventions consistent with the appropriate line of care. Historically each of these additional steps would have required separate prior authorization requests. These began in lung, breast, and prostate cancer to cover whole pathways of current and future screenings. We then built on this streamlining momentum to expand our prior authorization bundles to certain musculoskeletal procedures, where a single request authorizes a series of future procedures that can include X-rays, knee arthroplasty (THA/TKA) surgical procedure, anti-nausea and non-opioid pain medications, inpatient admission, infection control, and durable medical equipment. We have also begun bundling prior authorizations across pharmacy prescriptions and medical procedures for in vitro fertilization (IVF).
- Aetna is now embedding nurses within 17 major health systems to facilitate the necessary patient care and follow-up support they need to transition successfully out of the hospital, remain healthy, and reduce future readmissions. We project this program will reduce year-over-year 30-day readmissions and hospital length of stay by 5 percent.
Affordability
CVS Health works across our businesses to ensure each of the 185 million Americans we serve are receiving the right care at the right cost. We are expanding low-cost primary care, covering preventive care at no cost to patients, and offering free virtual care to eliminate barriers to access.
- We are expanding access to coverage that rewards providers for keeping patients healthy, not just treating illness. To date, we’ve made this shift for 80% of Medicare spending. This approach costs less, keep patients safer and healthier, and improves overall satisfaction. For multiple years running, the Centers for Medicare and Medicaid Services (CMS) have recognized our Medicare Advantage plans with industry-leading Star Ratings, measures of member satisfaction and health outcomes.
- We are driving competition to lower drug costs. We’re aggressively promoting the use of biosimilars, introducing alternatives for popular expensive branded drugs like Humira and Stelara. Our alternative to Humira has generated $1.3 billion in savings for our clients, and we introduced a biosimilar for Stelara at 86% less than the brand list price.
- In addition, we share these savings with consumers directly. Since 2019, Aetna has been sharing its negotiated pharmaceutical rebates directly with members when they fill their prescriptions at the pharmacy counter. Today, our pharmacy benefit manager CVS Caremark delivers rebate savings at the pharmacy counter for 25 million of our 87 million members, and Caremark’s TrueCost® solution enables our clients to transparently deliver direct-to-consumer value from the discounts we negotiate from drugmakers.
Community impact
In 2024, CVS Health delivered $474 billion in positive contributions to the United States economy. We employ more than 300,000 United States citizens, and indirectly create an additional one million jobs through the partners and vendors who work with us.
In an era when other major retail pharmacies have declared bankruptcy or turned to private equity, more than 85% of Americans live within 10 miles of one of our 9,000 community pharmacies. We continue to put the people of the United States first in the work we do to simplify health care. One patient, one family, and one community at a time.
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 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.
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SOURCE CVS Health
