Simplify Prior Authorization
A multi-stakeholder initiative led by Connex Health Consulting and The Pangaea Group.
The goal of this initiative is to create an industry solution to the challenges of prior authorization (PA) programs*.
This microsite has been developed to provide information on the Simplify Prior Authorization initiative to all stakeholders in the PA process and those with an interest in PA.
*Sometimes called special authorization programs.
The White Paper on Prior Authorization
Summary of what researchers found:
- 1Stakeholders* subject to the process would benefit from greater consistency between payers.
- 2More transparency in criteria and consistency in claim forms would improve the PA process.
- 3Stakeholders would benefit from changes to the current paper-based claims process to reduce the administrative burden.
- 4There is an opportunity to improve the consistency of the review and appeals process between payers.
- 5Patients on PA drugs would benefit from industry grandfathering standards to prevent loss of coverage on transfer of carriers.
- 6Payer metrics and stakeholder evaluations would identify opportunities to improve the PA process.
*Stakeholders include physicians, pharmacists, patient navigators, benefit advisors and plan sponsors/employers.
- 1Create a not-for-profit oversight agency.
- 2Create a web portal for all stakeholders with:
- /A repository of clinical evidence for payers
- /Lists of PA drugs by payer
- /Claim forms for PA drugs
- /Electronic submission of PA claims (ePA).
- 3Improve transparency in the PA process.
- 4Provide clear avenues for appeal.
- 5Develop industry grandfathering standards for PA.
- 6Identify common metrics and reporting for payers as well as evaluations for physicians, patients and patient navigators.
The Plan to Simplify Prior Authorization
It isn’t easy to create industry-level change, especially when there many stakeholders involved, so we’re tackling it in a multi-phased process with the participation of numerous experts:
The white paper report on Private Payer Prior Authorization.
The Steering Committee and working groups will respond to the recommendations of the white paper and create a new framework for PA.
The first pilots will go live and preparation will be finalized for full market launch.
In our first podcast Denise Balch from Connex Health Consulting spoke with Bev Herczegh from The Pangaea Group on the Simplify Prior Authorization White Paper and the vision for change.
Why Simplify Prior Authorization?
Prior Authorization and the Patient Impact
During research for the Simplify Prior Authorization (SPA) white paper in 2020, we learned how the prior authorization (PA) process was impacting patients.read more...
In November 2020 the Simplify Prior Authorization white paper was introduced at the Benefits Breakfast Club and the Prior Authorization Q&A Blog was developed to respond to questions and clarify important issues like payer autonomy, funding of the initiative and the benefits of simplifying the current prior authorization process.read more...
Prior Authorization Q&A – What You Need to Know
On the November 26, 2020 Benefits Breakfast Club webinar experts addressed innovations in oncology and the role of prior authorization (PA), including the many challenges of a largely paper-based PA process.read more...
How to Support Simplify Prior Authorization
We are building our financial support through sponsorship of this multi-stakeholder initiative. We also welcome contributions of time and expertise. To receive a copy of our sponsorship package contact us.
For More Information Contact
- ASTRA ZENECA
- Bristol Myers Squibb
- Gilead Sciences Canada, Inc.
- Innovative Medicines Canada
Get In Touch
If you have questions, are interested in finding out more about this initiative or providing support, please contact us.